Midweek Report

Obesity

Midweek Report

David Ermer–CDC, FDA, Generative AI, HIPAA Privacy and Security Rules, Medical / Rx research, Mental health care, NIH, Obesity, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Manasvita S on Unsplash

From Washington, DC,

  • Per HHS press releases,
  • and
    • “The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services (HHS), today released updated National Behavioral Health Crisis Care Guidance (National Guidance), comprised of three documents: 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care; Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services; and a draft Mobile Crisis Team Services: An Implementation Toolkit, which is being released today for public comment. The updated National Guidance now reflects the national transition to the 988 Suicide & Crisis Lifeline in 2022 and other progress and emerging needs related to behavioral health crisis care and provides a framework for transforming behavioral health crisis care systems in communities throughout the United States, at a time when the U.S. continues to face record high rates of suicide and overdose.”
  • and
    • “Today, the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a settlement with South Broward Hospital District d/b/a Memorial Healthcare System (Memorial Healthcare System), a Florida health system, concerning a potential violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule. The settlement resolves litigation resulting from an investigation about a complaint alleging a lack of timely access to an individual’s protected health information (PHI). The HIPAA Right of Access provisions require that individuals or their personal representatives receive timely access to their health information for a reasonable cost. OCR’s investigation determined that Memorial Healthcare System failed to provide timely access within 30 calendar days. Memorial Healthcare System has agreed to pay $60,000. The agreement marks OCR’s 52nd Right of Access enforcement action.”
  • The American Hospital Association News informs us,
    • “The Department of Health and Human Services and Drug Enforcement Administration published a series of rules Jan. 15 related to telemedicine prescribing of controlled substances, including a special registration proposed rule and a final rule on telemedicine prescribing of buprenorphine. 
    • “The proposed rule for special registration outlines three types of registration to waive in-person visit requirements prior to virtual prescribing of controlled substances and a state registration for every state in which a patient is treated by the special registrant. Providers would need to apply for the special registrations. The DEA also proposes that providers be required to review nationwide prescription drug monitoring programs after three years. Comments on the proposed rule are due March 15. 
    • “The DEA’s final rule for the telemedicine prescribing of buprenorphine will enable practitioners to prescribe a six-month initial supply of Schedule III-V medications to treat opioid use disorder via audio-only telemedicine interaction without a prior in-person evaluation. Practitioners can then prescribe additional medication via other telemedicine encounters (real-time, two-way audio-visual) or after an in-person encounter. The agency finalized a stipulation that providers will need to complete a review of the PDMP for the state where the patient is located. Requirements for the special registration proposed rule would not apply to clinicians prescribing buprenorphine for OUD.”
  • and
    • “The Centers for Medicare & Medicaid Services announced Jan. 15 that 53.4% of people with Traditional Medicare are in an accountable care relationship with a provider, a 4.3% increase from last year. The agency said it is the largest increase since it began tracking accountable care relationships. 
    • “For 2025, CMS approved 228 applications for the Medicare Shared Savings Program, bringing the total number of accountable care organizations participating in MSSP to 476. Approved applicants included 55 new ACOs and 173 renewing or reentering ACOs, the most in the program’s history.  
    • “CMS said there was also a 16% increase from last year in federally qualified health centers, rural health clinics and critical access hospitals participating in the MSSP. In addition, 103 ACOs are continuing participation in CMS’ ACO Realizing Equity, Access, and Community Health Model, and 78 kidney contracting entities and 15 CMS Kidney Care First Practices are continuing participation in the Kidney Care Choices Model.”  
  • The Census Bureau has partnered with the Department of Defense to track how veterans fare in labor market when they return to civilian life. Check out their report.

From the Food and Drug Administration front,

  • The Wall Street Journal reports
    • “Eli Lilly said it received Food and Drug Administration approval for its treatment for moderate to severely active Crohn’s disease, an inflammatory bowel disease that causes chronic abdominal pain.
    • “The treatment, developed by the pharmaceutical company under the brand name Omvoh, is now approved to treat two types of inflammatory bowel disease in the U.S., the Indianapolis company said Wednesday. The drug was previously approved to treat ulcerative colitis in adults in October 2023.
    • “Omvoh’s approval as a treatment for Crohn’s disease was based on results from a study in which 53% of patients treated with the drug achieved clinical remission, and 46% of patients had visible healing of the intestinal lining, at one year.”
  • and
    • The Food and Drug Administration is banning the use of Red No. 3, an artificial dye linked to cancer in animals, from food and ingested drugs.
    • The move will impact thousands of food products on the market in the U.S., including Betty Crocker’s loaded mashed potatoes and MorningStar Farms plant-based bacon strips. It is even in products that aren’t red, such as Brach’s candy corn. 
    • Food manufacturers will have until early 2027 to reformulate products that use Red 3. Consumer advocates pushed the agency to revoke authorization for the additive after two studies linked it to cancer in male laboratory rats. 
  • Roll Call adds,
    • “The Food and Drug Administration unveiled a proposal on Wednesday to limit the amount of nicotine allowed in cigarettes and some other combustible tobacco products, a final step for the agency before the Trump administration takes over next week.
    • The FDA first announced it would pursue regulatory changes to maximum nicotine levels in combustible smoking products in 2022 in an effort to reduce the public health effects related to addiction and minimize youth uptake.
    • “The agency is seeking public comment on the rule, but the proposal’s fate is unclear given the coming change in administration.”
  • STAT News described the last two FDA steps along with Tuesday’s proposal putting nutrition labels on the front of food packages as springing into Making America Healthy Again.

From the judicial front,

  • Beckers Payer Issues lets us know that insurer lawsuits over Medicare Advantage Star ratings are piling up.
  • STAT News relates,
    • “After years of sparring, the Biden administration and Gilead Sciences have settled a contentious lawsuit over patents for a pair of HIV prevention pills in a case that raised questions about the extent to which government-funded research should lead to affordably priced medicines.
    • “At issue was a battle over patents for Truvada and a newer, upgraded version called Descovy — two highly effective and lucrative medications — as well as the role played by the federal government in making it possible to prevent transmission of a highly infectious disease that plagued the American public for decades.
    • “The Centers for Disease Control and Prevention, which had funded academic research into HIV prevention that later formed the basis for the pills, maintained that Gilead infringed its patent rights. The U.S. Department of Health and Human Services also contended that the company had refused to reach a licensing agreement despite several attempts to strike a deal.
    • “Gilead, however, maintained it had invented the pills and that the concept of using Truvada to prevent HIV was well-known by the time the CDC tried to obtain its patents. The company also insisted it negotiated in good faith with the government. After a May 2023 trial, a jury sided with Gilead, finding it did not infringe on patents held by the CDC and, moreover, that those patents were invalid. The Biden administration, which sought $1 billion in royalties, subsequently appealed the decision.
    • “In a statement, the company said Wednesday that it will receive a license to “certain” current and future patents concerning HIV prevention that “will protect Gilead’s freedom to operate for years to come.” Any additional terms were not disclosed, although a Gilead spokeswoman wrote to say the settlement does not contain any payments from Gilead or the federal government.”

From the public health and medical research front,

  • The Hill reports,
    • “Respiratory illnesses are spreading throughout the U.S., causing multiple states to see a spike in hospital visits. The latest data shows another virus, known as HMPV, has also been spiking in some parts of the country. 
    • “The Centers for Disease Control and Prevention previously confirmed it was monitoring a spike in cases of HMPV, or human metapneumovirus, in China’s northern provinces. The agency noted the cases of the virus, which is not new, were not a “cause for concern in the U.S.” and that rates of infection nationwide are at typical “pre-pandemic” levels.
    • “HMPV is considered relatively common, with most infected before age 5, according to Dr. Eileen Schneider, an epidemiologist with the CDC. It often circulates during flu season and causes symptoms similar to the common cold, including coughing, wheezing, congestion and shortness of breath.” * * *
    • “Across Iowa, Kansas, Missouri and Nebraska, more than 5.8% of tests submitted for HMPV tested positive through the first week of the year, data shows. That’s more than double the positivity rate across the next-highest region — Alaska, Washington, Oregon and Idaho — which sits at around 2.7%.” * * *
    • “HMPV is typically diagnosed based on symptoms, the Cleveland Clinic explains, and not testing, unless you have serious symptoms.
    • “There are no vaccines or treatment therapies for HMPV, which makes preventing the spread of HMPV especially important. Health experts recommend washing your hands often and avoiding contact with those who are infected with HMPV if possible.”
  • Becker Hospital Review tells us,
    • “The latest data from the American Society of Health-System Pharmacists reports that the active number of drug shortages in the U.S. has decreased to 271, down from a high of 323 in the first quarter of 2024. However, despite this decline, ongoing challenges continue to burden healthcare providers.” 
  • and
    • “Eli Lilly expects its experimental weight loss pill, orforglipron, to receive approval as early as next year, CEO David Ricks told Bloomberg Jan. 13.
    • “The company is preparing to release key late-stage trial data on the drug by mid-2025. The weight loss pill aims to compete with popular injectable treatments like Eli Lilly’s own Zepbound and Novo Nordisk’s Wegovy, which currently dominate the space. 
    • “If approved, orforglipron would offer a pill alternative to the current injectables, making it easier for patients to use while also addressing manufacturing challenges. 
    • “In mid-stage trials, the drug helped patients lose up to 14.7% of body weight, compared to just 2.3% for those who took a placebo.”
  • The National Cancer Institute points out,
    • “For people with a history of smoking, a diagnosis of lung cancer can cause feelings of guilt and shame due to the stigma that’s often associated with the disease. This stigma can hinder open communication between patients and health care providers and hinder patients’ use of tobacco cessation counseling. Researchers at Memorial Sloan Kettering Cancer Center have developed a training program to help health care providers reduce lung cancer–related stigma. In this interview, the trial’s leaders, Smita Banerjee, Ph.D., a behavioral scientist, and Jamie Ostroff, Ph.D., a psychologist, discuss the impact of stigma on people with lung cancer and an NCI-supported clinical trial that’s evaluating the training program.”

From the U.S. healthcare business front,

  • Fierce Healthcare reports “As deadly fires continue to rage in Los Angeles, healthcare companies far and wide are stepping up to serve those affected. At least 24 people have died from the fires, and dozens remain missing.” Bravo.  
  • STAT News notes,
    • “When Eli Lilly last year started offering lower-priced vials of its blockbuster obesity drug Zepbound, which were previously sold in injectable pens, it framed the move as a way to expand patient access. But some experts weren’t convinced, noting that Lilly was only offering the lowest doses in vials, and the new prices, $399 or $549 a month, are still prohibitive for many patients.
    • “CEO Dave Ricks said Lilly is now considering expanding the vial offering. “We’d like to lower the entry cost, and we’d like to have more doses available. That’s not something we’re announcing today, but we see that as an option,” he said Tuesday at a taping of ”The Readout LOUD,” STAT’s biotech podcast.”
  • Kaufmann Hall shares its “Winter 2025 Kaufman Hall Report: Highlights from the 2024 Healthcare Leadership Conference.”
  • Per Healthcare Dive,
    • “Teladoc Health is joining an Amazon marketplace that aims to connect consumers with health benefits programs, the telehealth vendor said Monday.
    • “Now, eligible users can find and enroll in Teladoc’s diabetes, hypertension, pre-diabetes and weight management programs through Amazon’s Benefits Connector.
    • “The program could help drive enrollment in Teladoc’s chronic care offerings, executives said at the J.P. Morgan Healthcare Conference in San Francisco on Monday. “I wouldn’t count on it bringing revenue for us very quickly, but it is certainly something that we will continue to pursue in terms of growing our chronic care program,” Teladoc CFO Mala Murthy said.”
  • Medical Economics explains why 2024 was a ‘blockbuster year’ for concierge medicine.
  • Fierce Pharma offers news from the third day of JP Morgan healthcare conference.
  • Healthcare Dive discusses top healthcare technology trends in 2025. The shape of AI regulation will be uncertain under the Trump administration this year, while healthcare companies will continue bolstering cyber defenses to withstand increasing attacks, experts say.

Tuesday Report

David Ermer–ACA, AHRQ, CDC, Congress, FDA, Generative AI, Medical / Rx research, NIH, No Surprises Act, Obesity, OPM, Rx coverage, Telehealth, U.S. Healthcare–
OPM Headquarters a/k/a the Theodore Roosevelt Building

From Washington, DC

  • Today, the U.S. Office of Personnel Management released a list of its accomplishments during the Biden-Harris administration.
  • Here is a link to Andreessen Horowitz bio of Scott Kupor who is President elect Trump’s designee for OPM Director.
  • The Washington Post is maintaining a website outside its paywall providing comprehensive news on Mr. Trump’s nominations.
  • The Wall Street Journal reports,
    • “Two vaccine skeptics who had been advising Robert F. Kennedy, Jr. as he prepares to become health secretary have been sidelined by Trump transition officials, people familiar with the matter said, underscoring a split over immunizations in the “Make America Healthy Again” movement.
    • “Adviser Stefanie Spear and lawyer Aaron Siri had asked prospective administration hires about their beliefs around vaccines even if they were interviewing for posts that had little to do with immunizations, people familiar with the interviews said. Kennedy, whose hearings to lead the Department of Health and Human Services could start on Capitol Hill as early as next week, also lobbed questions related to inoculation, the people said.
    • “The questions were different from those asked in separate meetings with President-elect Donald Trump’s staff, according to some of the people. Trump’s team asked about topics traditionally important to conservatives, such as the size of government and deregulation.
    • “Siri is no longer advising the presidential transition, a transition spokeswoman confirmed, and people familiar with the matter said his vaccine stances played a role. Spear, who had told others she would be Kennedy’s chief of staff, was passed over for that post in favor of a veteran of the first Trump administration—in part because of her vaccine priorities and in part because of her lack of experience, according to people familiar with the matter.”
  • The No Surprises Act regulators, which group includes OPM, released FAQ 69 which concerns an important opinion from the U.S. Court of Appeals for the Fifth Circuit handed down October 30, 2024. The Court has not issued its mandate in the case while it considers the Texas Medical Association’s motion for rehearing and rehearing en banc. The FAQ also includes compliance advice about the No Surprises Act anti-gag clause.
  • Per a Federal Trade Commission news release,
    • “The Federal Trade Commission today published a second interim staff report on the prescription drug middleman industry, which focuses on pharmacy benefit managers’ (PBMs) influence over specialty generic drugs, including significant price markups by PBMs for cancer, HIV, and a variety of other critical drugs.
    • “Staff’s latest report found that the ‘Big 3 PBMs’—Caremark Rx, LLC (CVS), Express Scripts, Inc. (ESI), and OptumRx, Inc. (OptumRx)—marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by thousands of percent, and many others by hundreds of percent. Such significant markups allowed the Big 3 PBMs and their affiliated specialty pharmacies to generate more than $7.3 billion in revenue from dispensing drugs in excess of the drugs’ estimated acquisition costs from 2017-2022. The Big 3 PBMs netted such significant revenues all while patient, employer, and other health care plan sponsor payments for drugs steadily increased annually, according to the staff report.” 
  • STAT News adds,
    • “In response to the latest report, a CVS spokesperson wrote that “any proposed policy regulating PBMs should face a simple test: will this increase or decrease drug costs? Nearly all recently proposed ‘anti-PBM’ policies would ultimately increase U.S. drug costs and serve as a handout to the pharmaceutical industry. Instead of focusing on the impact to consumers and organizations that pay for prescription drugs, the FTC has prioritized comments from the conflicted pharmaceutical and pharmacy industries that would profit from a weakened PBM guardrail.”
    • “The company also argued it is “inappropriate and misleading to draw broad conclusions from cherry-picked” generic drugs. Between 2017-2022, specialty generic products have represented less than 1.5% of total spending on medicines by health plans contracted with CVS. In contrast, branded specialty products represent more than 50% of total spending.
    • “A spokeswoman for Cigna, which owns Express Scripts, wrote to say “this is another set of misleading conclusions based on a subset of medications that represent less than 2% of what our health plans spend on medications in a year — much like their first interim report that the FTC itself has already said is ‘limited’ and ‘tentative’. Nothing in the FTC’s report addresses the underlying cause of increasing drug prices, or helps employers, unions, and municipalities keep prescription benefits affordable for their members. We look forward to continuing to address the blatant inaccuracies in the Commission’s reports.”
    • “One Wall Street analyst maintained the FCC report does not tell the complete PBM story. TD Cowen analyst Charles Rhyee wrote in an investor note that “the fundamental issue with the FTC’s claims… is that they use only data on specialty generics, a small subset of the overall drug market – 0.9% of total drug spending – and is not representative of the value that the PBM industry delivers as a whole.”
  • Per a Food and Drug Administration press release,
    • “Today, the U.S. Food and Drug Administration is announcing an important step to provide nutrition information to consumers by proposing to require a front-of-package (FOP) nutrition label for most packaged foods. This proposal plays a key role in the agency’s nutrition priorities, which are part of a government-wide effort in combatting the nation’s chronic disease crisis. If finalized, the proposal would give consumers readily visible information about a food’s saturated fat, sodium and added sugars content—three nutrients directly linked with chronic diseases when consumed in excess.  
    • “The proposed FOP nutrition label, also referred to as the “Nutrition Info box,” provides information on saturated fat, sodium and added sugars content in a simple format showing whether the food has “Low,” “Med” or “High” levels of these nutrients. It complements the FDA’s iconic Nutrition Facts label, which gives consumers more detailed information about the nutrients in their food.” * * *
    • “Comments on the proposed rule can be submitted electronically to http://www.regulations.gov by May 16, 2025.”
       
  • The Wall Street Journal adds,
    • “It is unclear how the incoming Trump administration will view the rule. Robert F. Kennedy Jr., the prospective next head of U.S. health policy, is a critic of processed foods and has been outspoken about his view that U.S. food companies are partly to blame for sickening Americans.
    • “Consumer advocacy groups and public health organizations cheered the rule, though some said they hoped the Trump administration would consider labels similar to those adopted in other countries that bear more pointed warnings.
    • “Industry groups have warned the FDA that they could sue to challenge mandatory front-of-package labels. Such labels, they said, could threaten First Amendment rights—because companies could consider them a form of forced speech—and only Congress has the authority to require them.” 
  • The New York Times reports,
    • “Among both men and women, drinking just one alcoholic beverage a day increases the risk of liver cirrhosis, esophageal cancer, oral cancer and various types of injuries, according to a federal analysis of alcohol’s health effects issued on Tuesday.
    • “Women face a higher risk of developing liver cancer at this level of drinking, but a lower risk of diabetes. And while one alcoholic drink daily also reduces the likelihood of strokes caused by blood clots among both men and women, the report found, even occasional heavy drinking negates the benefits.
    • “The report, prepared by an outside scientific review panel under the auspices of the Department of Health and Human Services, is one of two competing assessments that will be used to shape the influential U.S. Dietary Guidelines, which are to be updated this year.”
  • Monica M. Bertagnolli, M.D., issued a statement on ending her tenure as NIH director January 17, 2025. The FEHBlog has enjoyed her Director’s blog entries.

From the public health and medical research front,

  • The U.S. Preventive Services Task Force today gave B grades to the following recommended preventive services:
    • “The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years or older.”
    • “The USPSTF recommends screening for osteoporosis to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk for an osteoporotic fracture as estimated by clinical risk assessment.”
  • and an inconclusive grade to the following preventive service
    • “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men.”
  • The USPSTF notes,
    • “This recommendation updates the 2018 USPSTF recommendation on screening for osteoporosis. In 2018, the USPSTF recommended screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years or older and in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.45 For the current recommendation, the USPSTF has noted that screening can include DXA BMD, with or without fracture risk assessment. The current recommendation is otherwise generally consistent with the 2018 recommendation.”
  • The Journal of the American Medical Association expands on this USPSTF note in an editorial comment.
    • “At first glance, the updated US Preventive Services Task Force (USPSTF) Recommendation Statement on osteoporosis screening1 appears nearly identical to the previous 2018 statement, especially regarding the recommendation for universal screening in women 65 years or older and insufficient evidence to support a recommendation for or against screening in men. However, subtle revisions to the 2018 recommendation2 may result in substantive changes in screening of younger postmenopausal women in clinical practice. While a B recommendation for higher-risk postmenopausal women younger than 65 years is common to both statements, the 2018 statement recommended assessing risk of osteoporosis in these women using a formal clinical risk assessment tool, whereas the 2024 Recommendation Statement1 recommends screening those at increased risk for an osteoporotic fracture as estimated by clinical risk assessment. Additionally, the screening test for both younger and older postmenopausal women in the 2018 recommendation is specified broadly as bone measurement testing. By contrast, the 2024 statement is more specific and defines screening as central (hip or lumbar spine) dual-energy x-ray absorptiometry (DXA) bone mineral density (BMD) testing with or without fracture risk assessment.
    • “In postmenopausal women younger than 65 years, osteoporosis screening presents several challenges. While time is often limited and resources scarce in the overstretched primary care practice environment, the USPSTF recommends a 2-step process to identify women in this age group who warrant screening. The clinician first determines whether traditional osteoporosis risk factors such as low body weight or tobacco use are present. For women with 1 or more risk factors, the USPSTF then advises risk assessment with a clinical risk assessment tool (eg, the Osteoporosis Self-Assessment Tool [OST], the Osteoporosis Risk Assessment Instrument [ORAI], or the Fracture Risk Assessment Tool [FRAX]) calculated without BMD information to further select women who warrant BMD testing. Primary care clinicians should be aware that the OST and ORAI were designed to identify osteoporosis (BMD T score ≤−2.5), while FRAX was developed to estimate 10-year absolute probabilities of hip and major osteoporotic fracture. Use of the OST or ORAI entails a simple calculation with few inputs (e.g., the OST is based on age and weight alone), whereas use of FRAX requires entering information on 11 clinical risk factors into a web-based algorithm. Table 2 in the Recommendation Statement1 provides “frequently used thresholds for increased osteoporosis risk” for OST (score <2) and ORAI (score ≥9), indicating that these thresholds identify women for whom central DXA BMD testing is suggested. In contrast to the 2011 and 2018 recommendations, the 2024 USPSTF Recommendation Statement1 does not suggest a specific FRAX threshold to define increased osteoporosis risk.
  • Per a National Cancer Institute news release,
    • “Feeding fructose to lab animals with cancer made their tumors grow faster, a new study has shown. But the tumors didn’t directly consume fructose, the researchers found. Instead, the liver converted it into a type of fat that cancer cells gobbled up.
    • “Studies have suggested that diets containing excess fructose—which is found in high-fructose corn syrup and table sugar—can help tumors grow. But how this common dietary sweetener might do so has been a bit of a mystery. The researchers believe their study provides some important answers. 
    • “The NIH-funded study, published December 4 in Nature, showed that several types of cancer cells lacked the enzyme needed to use fructose directly. However, liver cells have the necessary enzyme, called KHK, and used it to convert fructose into fats called lipids. 
    • “The findings could open up a new avenue for potential cancer treatments, said the study’s senior researcher, Gary Patti, Ph.D., of Washington University in St. Louis. A drug that blocks the KHK enzyme slowed fructose-fueled tumor growth in mice, the scientists showed.”
  • The National Institutes of Health released an NIH research matters bulletin concerning “Cancer prevention and screening | Improving flu vaccines | LDL structure.”
  • AP reports,
    • “A group of global experts is proposing a new way to define and diagnose obesity, reducing the emphasis on the controversial body mass index and hoping to better identify people who need treatment for the disease caused by excess body fat. 
    • “Under recommendations released Tuesday night, obesity would no longer be defined solely by BMI, a calculation of height and weight, but combined with other measurements, such as waist circumference, plus evidence of health problems tied to extra pounds. 
    • “Obesity is estimated to affect more than 1 billion people worldwide. In the U.S., about 40% of adults have obesity, according to the U.S. Centers for Disease Control and Prevention. 
    • “The whole goal of this is to get a more precise definition so that we are targeting the people who actually need the help most,” said Dr. David Cummings, an obesity expert at the University of Washington and one of the 58 authors of the report published in The Lancet Diabetes & Endocrinology journal.”
  • Per MedPage Today,
    • “Integrating smoking cessation into a lung cancer screening program had the biggest benefit for patients who wanted to quit, a randomized trial showed.
    • “Self-reported tobacco abstinence was greater at both 3 and 6 months with higher levels of integration of smoking cessation assistance in the lung cancer screening program, reported Paul Cinciripini, PhD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues in JAMA Internal Medicine.”
  • and
    • “Antiviral drugs commonly used to treat non-severe influenza appeared to have little or no effect on key clinical outcomes, except for baloxavir (Xofluza), according to a systematic review and meta-analysis of 73 randomized trials.”

From the U.S. public health front,

  • STAT News adds,
    • “Since society rebounded from the pandemic, Teladoc Health has gone from a soaring rocket ship considered an emblem of the potential of health tech to a cautionary tale about overblown hype. Its telehealth services are now viewed by many as an interchangeable commodity in a crowded market.
    • “In his first prominent public appearance as CEO of the virtual care giant, Chuck Divita showed up [at the JPM Conference] and played the part — promising growth and stability and reminding investors of the company’s strong foundation.”
  • Beckers Hospital Review points out,
    • Eli Lilly is leading a push with other pharmaceutical companies to request a pause in the Biden administration’s drug pricing negotiations, even as officials prepare to release a new list of medications to be targeted for price reductions, Bloomberg reported Jan. 13. 
    • Speaking at the JPMorgan HealthCare Conference in San Francisco, Eli Lilly CEO Dave Ricks emphasized the need for changes to the Inflation Reduction Act before additional drugs are included in the program. 
  • MedCity News relates, “Nvidia announced four new partnerships focused on scaling AI models across the healthcare industry. The company is teaming up with Mayo Clinic, Illumina, IQVIA and Arc Institute” at JPM Conference.
  • BioPharma Dive lets us know,
    • “Eli Lilly on Tuesday said the company’s revenue in 2024 totaled about $45 billion, a 32% jump on 2023’s total but less than what it had estimated in October.
    • “Third quarter sales of Mounjaro and Zepbound, its GLP-1 drugs for diabetes and obesity, were below Wall Street analysts’ expectations at $3.5 billion and $1.9 billion, respectively. CEO David Ricks said GLP-1 market growth was slower than the company anticipated.
    • “Shares of the Indianapolis-based company fell by as much as 8% in morning trading, shaving tens of billions of dollars from its market valuation. Since hitting a high of $960 apiece in late August, shares have tumbled in value by about one-fifth as Zepbound sales have fallen short of forecasts.”
  • McKinsey & Company explains “How healthcare entities can use M&A to build and scale new businesses.”

Thursday Report

David Ermer–CDC, CMS, Congress, FDA, Generative AI, Medical / Rx research, Obesity, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Josh Mills on Unsplash

From Washington, DC

  • Tammy Flanagan, writing in Govexec, discusses, “The Social Security Fairness Act: What we know so far.  It may take time to implement this new law — here’s what you should know for now.”
    • “It will undoubtedly take time to implement this new law as it impacts about two million beneficiaries who have their earned Social Security benefits reduced because of the WEP, and close to 750,000 individuals who have had spousal and widow’s benefits payable based on the Social Security work record of their current, former or deceased spouse.  
    • “The repeal of the WEP and GPO will increase the Social Security benefit entitlements of the government worker or retiree who is receiving a pension from work not covered by Social Security. For most of you reading today’s column, this would be the CSRS employees and retirees who are married or were married to a spouse who paid Social Security taxes and the CSRS employee or retiree who earned their own Social Security retirement benefit in addition to receiving a CSRS retirement benefit.  
    • “The WEP can also affect CSRS Offset employees and retirees as well as some employees or retirees who transferred to FERS after more than five years of creditable service under CSRS.”
  • The American Hospital Association News tells us,
    • The Centers for Medicare & Medicaid Services will host a webinar Jan. 16 at 1 p.m. ET to provide an update on the No Surprises Act Good Faith Estimate requirements for uninsured and self-pay patients. Experts will discuss the recent GFE FAQs with a focus on implications for providers and facilities. REGISTER NOW” 

From the public health and medical research front,

  • Per Medical Economics,
    • Screening for physical inactivity during routine medical visits can play a pivotal role in the identification of patients at risk for chronic diseases, according to a study published in Preventing Chronic Disease, a journal of the U.S. Centers for Disease Control and Prevention (CDC). Using the Exercise Vital Sign (EVS), researchers found that patients screened for physical activity had healthier profiles and fewer comorbid conditions than those who were not screened.
  • WTW Consulting informs us,
    • More and more evidence show that GLP-1 medications are good for losing weight and reducing the amount of metabolic disease in people with obesity. But only about 52% of employers currently cover these drugs for obesity, and these employers are facing rising costs.
    • Previous research has shown that the cost of these drugs will exceed any medical cost savings, as is true for most medical interventions. For example, medical plans don’t save money by treating cancer or providing dialysis for patients with kidney failure.
    • JAMA Network Open recently published a study that showed that healthcare spending could decrease based on the type of weight loss seen with use of GLP-1 medications. However, the study demonstrates once again that even with their impressive impacts on patient weight and health, an employer-sponsored health insurance plan should not expect net medical savings from these medications.
    • The researchers looked at medical claims from over 13,000 commercially insured adults from the Medical Panel Expenditure Survey from 2001 to 2020 and found that medical spending was lower in those who weighed less. Therefore, cost effectiveness of an effective weight loss drug would be much higher in those with higher BMIs, especially in those with diabetes. 
    • However, the study didn’t evaluate people who had lost weight, but rather examined differences in costs based on BMI. Those who lose weight won’t necessarily have the same lower level of expense as those who weren’t previously obese. Even if their estimate of cost “savings” is correct, the net cost of semaglutide or tirzepatide is around $9,000 annually, which is more than the delta in costs for a person with diabetes who loses 25% of their body weight.
    • Implications for employers: 
      • An employer-sponsored health insurance plan should not expect net medical savings from these medications, even with their impressive impacts on patient weight and health.
      • The decision to cover these medications should be based on the benefit they offer, and not the hope of lower medical expenses. Lower prices would allow more people to benefit from these medications.
  • The Wall Street Journal warns us,
    • Wildfires in California aren’t all wild anymore. They often burn in urban areas, creating a toxic soup of smoke, ash and noxious substances that can be dangerous, even deadly. 
    • In Los Angeles this week, wildfires have burned buildings and roadways. Incinerating the plastics, metals and other materials that these structures are built from releases hazardous chemicals and gases into the air, doctors and public-health experts say. 
    • Wildfires which tear through urban landscapes release chemicals from human-made fuels, construction materials, household products and generate emissions which are chemically different from wildland fires, according to a 2022 report from the National Academies of Sciences, Engineering and Medicine. About 70,000 communities and 43 million homes are at risk from fires that could burn through both wild and urban landscapes, the report stated.
    • “The combination of wildfire smoke in conjunction with human elements might be even more dangerous,” said Dr. Sanjay Rajagopalan, chief of cardiovascular medicine at University Hospitals Harrington Heart & Vascular Institute in Cleveland. “When you burn plastic, for instance, or you burn rubber, you get some pretty nasty stuff.”
    • Smoke from the Los Angeles wildfires could have far-reaching effects. Depending on weather patterns and geographic conditions, smoke can travel vast distances. Tens of thousands of Los Angeles County residents have already been ordered to evacuate.
  • BioPharma Dive points out,
    • “An experimental menopause drug from Bayer succeeded in a late-stage trial in women taking drugs to treat or prevent breast cancer, the company said Thursday.
    • “Bayer said the drug, elinzanetant, significantly reduced the frequency of hot flashes and improved sleep for women with breast cancer, or who are at high risk of developing it, and whose symptoms are caused by hormone therapy. The study randomized 474 women to receive treatment or a placebo and measured the effects after four and 12 weeks.
    • “The announcement represents the fourth positive late-stage study result for elinzanetant, but the first that isn’t in menopausal women. Bayer has already submitted the drug for U.S. approval in postmenopausal women, and the Food and Drug Administration accepted its application in October. If cleared by regulators, the drug would compete with Astellas Pharma’s Veozah.”
  • Per Fierce Pharma,
    • “Trailing Johnson & Johnson’s powerhouse Darzalex by roughly five years in its development timeline has made it challenging for Sanofi’s Sarclisa—the only other CD38 antibody on the market for multiple myeloma—to compete in the indication.
    • “But with an on-body delivery system (OBDS) to deliver its subcutaneous (SC) formulation of Sarclisa, Sanofi may be finding the edge it needs.
    • “The company has taken a major step in the development of its OBDS as a phase 3 trial has met its primary co-endpoints, showing non-inferiority to intravenous (IV) Sarclisa. The company reported the trial result in a press release Thursday.”

From the U.S. healthcare business front,

  • Health Dive relates,
    • “Blue Shield of California, one of the largest plans in the state, has revamped its corporate structure and named its first-ever female CEO.
    • “Blue Shield created a parent company called Ascendiun to oversee the insurer, along with its managed Medicaid subsidiary and clinical services firm Altais, starting Jan. 1, the company announced Wednesday. Ascendiun also includes a newly created health services business called Stellarus, which aims to scale and sell Blue Shield’s pharmacy and technology offerings to other insurers.
    • “Lois Quam, who has been Blue Shield’s president since last year, will step up as chief executive of the insurer. Quam will be the first woman to serve as Blue Shield’s CEO in the organization’s 86 years of operation. Paul Markovich, Blue Shield’s CEO for over a decade, will become president of Ascendiun and will also lead Stellarus on an interim basis.”
  • and
    • “Amwell is selling its virtual psychiatric care business to fellow telehealth provider Avel eCare for about $21 million in cash, the company said Thursday. 
    • “The divestiture, which includes an additional earn-out payment for Amwell if the business meets financial targets, includes the psychiatric care segment’s technology and personnel along with Asana, a clinical network that employs and contracts with the unit’s clinicians. 
    • “Amwell CEO Ido Schoenberg said in a statement the sale strengthens the telehealth firm’s balance sheet and “fortifies our confidence” to reach positive cash flow in 2026.”
  • The American Hospital Association announced,
    • “The AHA today released its 2025-2027 Strategic Plan, approved by the AHA Board of Trustees in November. The plan is rooted in four core disciplines — advocacy and representation, thought leadership, knowledge exchange, and agents of change. It also includes nine principles that serve as the foundation of the AHA’s work and strategies to help the field make progress on its mission of advancing health in America. View the 2025-2027 Strategic Plan for more information.”
  • Modern Healthcare notes,
    • Oakland, California-based Kaiser Permanente led a $275 million Series F funding round for Innovaccer, a company that sells technology to unify patient data across health systems.
    • Innovaccer said the round will help it introduce new artificial intelligence and cloud capabilities. The company also said the new capital will help it to continue scaling a developer ecosystem that can allow health systems to implement AI tools with other third-party vendors.
  • NCQA suggests “Health Care Trends to Watch in 2025.”
  • Per Fierce Healthcare,
    • “A new report from Press Ganey highlights the close relationship between patient experience and health plan star ratings.
    • “Researchers polled 450,000 people across 200 plans and combined those survey results with its database of 5.5 million patient encounters. It found that people who gave poor scores for safety and privacy in surveys following a visit to their primary care providers also frequently awarded their health plan one star on quality and access to needed care on Medicare consumer services.
    • “The report noted these are critical data for plans to consider, as they have traditionally focused on making improvements to customer service, benefit design and patient engagement. It suggests they should also be considering ways to address safety.
    • “In addition, the survey found that patients expect easy access to primary care, but their ability to reach specialists is a key differentiator. Plans that earned four or more stars connected a higher proportion of their members with specialty care.”
  • MedTech Dive points out “five medtech trends to watch in 2025. After a busy 2024, experts called out competition in soft tissue robotics, uncertainty from a Trump White House and continued success for pulsed field ablation as trends to watch this year.”

Tuesday Report

David Ermer–CDC, Congress, Medical / Rx research, Obesity, OPM, Rx coverage, U.S. Healthcare–
OPM Headquarters a/k/a the Theodore Roosevelt Building
  • In a press release, OPM patted itself on the back for successfully launching the Postal Service Health Benefits Program.
  • Govexec adds,
    • “The Office of Personnel Management on Tuesday issued guidance to agencies reminding them of how to handle the pay and benefits of political appointees who are set to resign ahead of President-elect Trump’s inauguration on Jan. 20.
    • “In a memo to agency human resources directors, OPM associate director for workforce policy and innovation Veronica Hinton wrote that agencies should compensate appointees who are planning on resigning at noon on Inauguration Day—when Trump is slated to be sworn into office—for the hours they are scheduled to work before that time.” * * *
    • “Hinton’s memo also addresses the fact that Inauguration Day, which Washington, D.C., area federal workers receive as a holiday due to the congestion resulting from the proceedings, happens to fall on another federal holiday: Martin Luther King, Jr. Day.
    • “In short, there are no so-called “in-lieu-of” holidays entitling employees who typically work Mondays to an extra day off in light of the two holidays’ confluence. But if a D.C.-area employee’s normal work schedule does not include Mondays, they would receive one “in-lieu-of” holiday.”
  • Speaking of political appointees leaving on Inauguration Day, an HHS press release lets us know “United States Surgeon General Dr. Vivek Murthy released his Parting Prescription for America – PDF, weaving together reflections on his personal and professional experiences having spent six of the last ten years as our nation’s Surgeon General.”
  • Fierce Healthcare tells us,
    • “The Federal Consumer Financial Protection Bureau on Tuesday issued new regulations barring medical debts from American credit reports, enacting a major new consumer protection just days before President Joe Biden is set to leave office.
    • “The rules ban credit agencies from including medical debts on consumers’ credit reports and prohibit lenders from considering medical information in assessing borrowers.
    • “These rules, which the federal watchdog agency proposed in June, could be reversed after President-elect Donald Trump takes office Jan. 20. But by finalizing the regulations now, the CFPB effectively dared the incoming Trump administration and its Republican allies in Congress to undue rules that are broadly popular and could help millions of people who are burdened by medical debt.”
    • FEHBlog note — The rule does not take effect until early March. The FEHBlog hopes that the incoming Administration will cancel this rule making which is bound to disrupt the U.S. credit market.
  • Per a Senate press release,
    • Today, Senators Sheldon Whitehouse (D-RI) and Chuck Grassley (R-Iowa), in their respective capacities as Chairman and Ranking Member of the Senate Budget Committee during the 118th Congress, released a bipartisan staff report on the findings of their investigation into the ways in which private equity investment in health care has negative consequences for patients and providers. 
    • The Committee focused on two private equity firms—including the single-largest private equity investor in health care—that currently or previously invested in two prominent hospital operators.  Throughout the course of its investigation, the Committee reviewed more than one million pages of documents from Leonard Green & Partners, Prospect Medical Holdings, Medical Properties Trust, Apollo Global Management (Apollo), Lifepoint Health, and Ottumwa Regional Health Center, a for-profit Iowa hospital, that revealed new information about the business dealings of private equity-owned hospital operators.  Documents obtained by the Committee detailed how private equity’s ownership of hospitals earned investors millions, while patients suffered and hospitals experienced health and safety violations, understaffing, reduced quality of patient care, and closures. 
    • “Private equity has infected our health care system, putting patients, communities, and providers at risk,” said Chairman Whitehouse. “As our investigation revealed, these financial entities are putting their own profits over patients, leading to health and safety violations, chronic understaffing, and hospital closures.  Take private equity firm Leonard Green and hospital operator Prospect Medical Holdings: documents we obtained show they spent board meetings discussing profit maximization tactics—cost cutting, increasing patient volume, and managing labor expenses—with little to no discussion of patient outcomes or quality of care at their hospitals.  And while Prospect Medical Holdings paid out $645 million in dividends and preferred stock redemption to its investors—$424 million of which went to Leonard Green shareholders—it took out hundreds of millions in loans that it eventually defaulted on.  Private equity investors have pocketed millions while driving hospitals into the ground and then selling them off, leaving towns and communities to pick up the pieces.”
    • “The Ottumwa community has personally felt the impact of private equity on its health care system.  Under private equity ownership, wait times at Ottumwa Regional Health Center have gone up as patient experience has gone down. The diminishing quality of care, service availability and care capacity at the hospital is forcing Ottumwa residents to travel significant distances in order to receive appropriate treatment. Iowans deserve better,” Grassley said. “A dependable health care system is essential to the vitality of a community.  As always, sunshine is the best disinfectant.  This report is a step toward ensuring accountability, so that hospitals’ financial structures can best serve patients’ medical needs.”  
    • Read the full report here, and view the documents released by the Committee here and here.

From the public health and medical research front,

  • Here is a link to the Centers for Disease and Control and Prevention’s respiratory virus updates.
  • STAT News reports
    • “At Tufts University in Medford, Mass., researchers loaded a tiny 3D model of the human brain into a plastic shell resting atop a spring-loaded platform. Inside this polymer skull, the donut-shaped ball of living brain tissue floated in a warm, salty bath, its neurons whispering to each other in the darkness. Then a piston struck the platform, whipping it back and forth, and sending the mini-brain sloshing.
    • “Days later, as the team assessed the damage, the results were stark. Some of the human brain-like tissue had been housing a latent infection with a herpes virus, the type that causes cold sores. And the impact of the piston — intended to mimic a concussion — had woken that virus up. In those tissues, the researchers found lots of inflammation, newly formed plaques of sticky amyloid proteins, and all around them dying neurons — the signature marks of Alzheimer’s disease. Meanwhile, infection-free brain tissues recovered from the concussion with just a bit of lingering inflammation. 
    • “Decades of epidemiological data have shown that infections with herpes simplex virus type 1, or HSV-1 can raise the risk of Alzheimer’s disease in certain people. So can a history of head injury. The new research, published Tuesday in Science Signaling, is the first to connect the dots between them, and adds to mounting evidence that this most common form of dementia can be caused by an everyday microbe.”
  • Per Fierce Pharma,
    • “It’s now official: Johnson & Johnson’s combination of Rybrevant and Lazcluze has racked up an overall survival (OS) victory against AstraZeneca’s standard-of-care Tagrisso as a first-line treatment for advanced or metastatic non-small cell lung cancer (NSCLC).
    • “In reporting positive top-line results from the phase 3 MARIPOSA study in 1,074 patients with NSCLC with EGFR exon 19 deletions or L858R substitution mutations, J&J’s combo is expected to keep patients alive for at least a year longer than Tagrisso.
    • “The results, details of which are yet to be revealed, show a statistically significant and clinically meaningful improvement in OS, according to J&J.” 
  • BioPharma Dive points out,
    • “A landmark study hoping to find new treatments for ALS has notched two more failures, as experimental medicines from Denali Therapeutics and Calico Life Sciences proved no better than a placebo at slowing the nerve-destroying disease or keeping patients alive longer.
    • “Denali disclosed high-level results from the study Monday. After about six months, treatment with the company’s drug didn’t result in any significant changes in the severity of the disease, nor did it substantially help patients’ muscle strength or respiratory function.
    • “Denali plans to further examine the data and look at biological markers of the disease, including one, “neurofilament light chain,” that’s become increasingly important to researchers focused on amyotrophic lateral sclerosis. The company expects to conduct those analyses later this year.”
  • and
    • “Privately-held biotechnology startup Metsera said Tuesday a long-acting GLP-1 shot it’s developing helped people who are overweight or have obesity lose more weight than placebo recipients in a Phase 2 trial. 
    • “Study participants who received the shot, dubbed MET-097i, lost on average 11% more of their body weight than those who got a placebo over the course of 12 weeks. Placebo-adjusted weight loss also reached around 20% in those who received the highest dose, comparable to what was observed in tests of Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy over a similar period.
    • “Metsera also said data from the trial support plans to test MET-097i as a monthly injection, less frequent than the weekly shots Zepbound and Wegovy require. The announcement is the latest step forward for a company that has raised more than half a billion dollars since launching last April to support a bid to challenge Lilly and Novo’s medicines.” 
  • Cardiovascular Business adds,
    • “Semaglutide is associated with significant cardiovascular benefits for overweight and obese patients who have previously undergone coronary artery bypass graft (CABG) surgery, according to new data published in the Journal of the American College of Cardiology.
    • “Semaglutide is a popular GLP-1 receptor agonist being sold by Novo Nordisk under the brand names Wegovy and Ozempic. GLP-1 receptor agonists were originally developed to treat diabetes, but they are being used more and more to help obese and overweight patients lose weight. 
    • “For this latest analysis, researchers tracked data from the SELECT trial, originally designed to examine semaglutide’s impact among overweight/obese patients without diabetes, and focused exclusively on more than 2,000 patients with a prior history of CABG. The patients had a mean age of 65 years old, 84.2% were men and the mean BMI was 31.9 kg/m2. A history of hypertension was seen in 85.6% of patients. The rates of pre-existing atrial fibrillation and heart failure were 12.5% and 33.4%, respectively. 
    • ‘The study’s results confirmed that CABG patients still face an elevated risk of ischemic cardiovascular events following treatment. And once again, researchers wrote, semaglutide has been linked to “significant and consistent reductions” in the risk of such events.” 
  • The Wall Street Journal reports,
    • “A new study is helping to answer a pressing nutrition question: Which ultra-processed foods are harming our health—and which might not be so bad? 
    • “The problem is the way many packaged foods are made, researchers believe. Products such as many frozen pizzas, cereals and chips pack more calories per gram than less-processed foods do. And most ultra-processed foods have combinations of salt, fat, sugar and carbohydrates that aren’t generally found in nature, which can make us crave them. Diets high in packaged foods without those traits—such as canned peaches or refried beans—don’t seem to lead people to overeat and gain weight, at least not as much.
    • “Those are the findings so far of a continuing study investigating how ultra-processed food affects our bodies. Scientists presented their interim data at a workshop put on by the National Institutes of Health and the U.S. Food and Drug Administration in December. 
    • “There might be a way to create the quote, unquote healthy ultra-processed food that’s still convenient,” said Kevin D. Hall, the principal investigator of the study and a scientist at the NIH, giving an example of a frozen meal with brown rice, beans and a lot of vegetables.” 

From the U.S. healthcare business front,

  • STAT News reports,
    • “The advent of the first generic GLP-1 drugs could help Medicare negotiate a lower price for the highly sought after diabetes and obesity medication semaglutide, according to experts familiar with the price-negotiation program and STAT’s review of documents from the first round of negotiations.
    • “The Food and Drug Administration approved generics for the diabetes drugs exenatide and liraglutide in November and December. While those drugs don’t work as well as semaglutide, their much lower costs could give Medicare leverage to push for lower prices for semaglutide, two experts said.
    • “It’s hard to make an argument that liraglutide is not clinically comparable to the other GLP-1,” said Institute for Clinical and Economic Review President Sarah Emond.
    • “Both the nonpartisan Congressional Budget Office and academic experts expect semaglutide, sold by Novo Nordisk under the brand names Ozempic and Wegovy, to be among the next 15 drugs up for price negotiation. Medicare will announce that list by Feb. 1, and the negotiated prices will take effect in 2027.” 
  • Fierce Pharma notes,
    • “With COVID vaccine sales in the doldrums and a respiratory syncytial virus (RSV) vaccine market in “contraction”, Moderna CEO Stéphane Bancel had the unenviable task of trying to put a positive spin on a sharp stock decline in his annual shareholder letter.
    • “After an unexpectedly limited RSV vaccination recommendation from the CDC resulted in a “contraction” in the U.S. market, Moderna will adjust its financial reporting traditions to exclude products in their launch year, Bancel said Monday in his annual letter to shareholders.
    • “The company was “too optimistic about our ability to break into the market given the headwinds from a midyear approval and launch,” the Moderna CEO wrote about the RSV launch. “We are taking those learnings to heart and going forward, we will not include revenue from products in their launch year in our financial framework,“ he added.”
  • Per MedTech Dive,
    • “Stryker has agreed to acquire Inari Medical for approximately $4.9 billion, the company announced late Monday. The transaction is expected to close in the first quarter.
    • “Under the deal, Stryker would acquire all of Inari’s shares for $80 per share in cash, a premium of more than $30 over Friday’s closing price. Inari’s stock price closed at $65 Monday after surging by more than 30% in day trading.
    • “Inari would continue a busy year of dealmaking for Stryker in 2024, which included acquisitions of the artificial intelligence company Care.ai, the back pain device maker Vertos Medical and Nico Corporation, which makes devices to remove brain tumors and clots. Stryker did not disclose financial terms for the three deals.”
  • The Drug Channels Blog headlines “Inflation-Adjusted U.S. Brand-Name Drug Prices Fell for the Seventh Consecutive Year as a New Era of Drug Pricing Dawns.” Check it out.
  • Health Day relates,
    • “Patients have more access to their own medical test results than ever before, thanks to legislation requiring results be released as soon as they’re available.
    • “But that’s not necessarily a good thing, a new study warns.
    • “Many patients are reading test results in their electronic medical record before their doctor has had a chance to go over them, researchers say in a study published Jan. 2 in the Journal of the American Medical Association.
    • “This is provoking a lot of confusion and anxiety, mainly because medical reports contain a lot of jargon the average patient doesn’t understand, researchers said.
    • “For example, “a standard pathology report is written by a pathologist for a clinical specialist like a surgeon or a cancer doctor or for other pathologists to read,” lead researcher Dr. Cathryn Lapedis, a pathologist at University of Michigan Health, said in a news release from the college.
    • “To address this, Lapedis and her colleagues tested whether patients might benefit from pathology reports written in a way they would better understand.”

Thursday Report

David Ermer–Congress, FDA, Medical / Rx research, NIH, Obesity, U.S. Healthcare–

From Washington, DC,

  • According to the House of Representatives and Senate press galleries, each body will assemble before noon to adjourn the 118th Congress sine die and at noon will convene for the start of the 119th Congress.
  • Govexec tells us,
    • “Current federal employees, retirees and others impacted by widespread breach of personal data maintained by the Office of Personnel Management took advantage of only a small portion of the money made available in a settlement agreement following the 2015 hack. 
    • “Plaintiffs in the class action lawsuit reached a settlement in 2022 with the government that made $63 million available for those who could demonstrate financial hardship as a result of the breach. A federal judge closed out the case last month after OPM and the Treasury Department doled out just $4.8 million to just more than 5,000 individuals. The remaining $58.2 million is set to go back to the Treasury on Thursday, according to court documents last month.” 

From the public health and medical research front,

  • The Washington Post reports, “More children are getting kidney stones. Experts think it’s their diet.”
    • “Some research suggests that genetic predisposition may play a role, but experts say the increase more likely reflects dietary habits and lifestyle.
    • “A North Carolina doctor detected a potential culprit: salt-laden diets. Sodium intake has increased significantly among children in the past few decades.
    • “There is so much added salt to the American diet today, and when the kidney is excreting the sodium, it pulls calcium with it and increases the risk of calcium-based stones,” John S. Wiener, a pediatric urologist at Duke Health, said.”
  • The American Medical Association discusses “Raw milk: Questions patients may have and how to answer.” Econtalk host Russ Roberts chats with Brown University economist Emily Oster about raw milk and similar public health issues in his latest podcast.
  • HealthDay lets us know,
    •  “Alzheimer’s disease experts have updated their diagnosis guidelines for the first time in more than 20 years, laying out how family doctors and brain specialists can best detect dementia.
    • “The guidelines call for the use of three general criteria to assess a person’s brain health, according to a report published Dec. 23, 2024, in the journal Alzheimer’s & Dementia:
      • “The patient’s overall level of cognitive impairment
      • “Specific symptoms they’re suffering, which can involve memory, reasoning, language or mood
      • “Brain diseases most likely to be causing these symptoms
    • “These three areas of diagnosis were intentionally left broad, so that new tests can be incorporated into the guidelines as researchers learn more about dementia and Alzheimer’s, Dr. Alireza Atri, a lecturer on neurology at Harvard Medical School, said in a news release from the Alzheimer’s Association.”
  • Per National Institutes of Health news releases,
    • “Based on new brain mapping research funded by the National Institutes of Health (NIH), scientists have discovered that not all cell types in the brain age in the same way. They found that some cells, such as a small group of hormone-controlling cells, may undergo more age-related changes in genetic activity than others. The results, published in Nature, support the idea that some cells are more sensitive to the aging process and aging brain disorders than others.
    • “Aging is the most important risk factor for Alzheimer’s disease and many other devastating brain disorders. These results provide a highly detailed map for which brain cells may be most affected by aging,” said Richard J. Hodes, M.D., director of NIH’s National Institute on Aging. “This new map may fundamentally alter the way scientists think about how aging affects the brain and also provide a guide for developing new treatments for aging-related brain diseases.”
    • “Scientists used advanced genetic analysis tools to study individual cells in the brains of 2-month-old “young” and 18-month-old “aged” mice. For each age, researchers analyzed the genetic activity of a variety of cell types located in 16 different broad regions — constituting 35% of the total volume of a mouse brain.”
  • and
    • ‘In a small clinical trial, a CAR T-cell therapy—a type of immunotherapy that uses a patient’s own immune cells to fight cancer—shrank tumors in several children and young adults with diffuse midline gliomas. This fast-growing form of brain and spinal cord cancer typically causes death within a year of diagnosis.
    • “In the trial, several participants were still alive 2 years or more after receiving the treatment.” * * *
    • “This study breaks new ground,” said study co-investigator Crystal L. Mackall, M.D., of Stanford Medicine. “It demonstrates that CAR T cells can have real, meaningful benefit for solid cancers, something that many people have not believed [was possible].”  
    • “In the trial, 9 of 11 patients who received the GD2 CAR T-cell therapy had neurological improvement. Of those, 7 had tumor shrinkage and in some cases the effects were quite dramatic. As patients’ tumors shrank, their symptoms improved and many regained physical functions they had lost from the disease, such as hearing, walking, and taste sensation. 
    • “Participants lived a median of nearly 2 years after treatment, with two patients still alive past the study’s 2.5-year follow-up period. One of these patients had a complete disappearance of his tumor and remains cancer free 4 years after his diagnosis. 
    • “It’s really remarkable,” said Rosandra N. Kaplan, M.D., of NCI’s Center for Cancer Research, who is also running a GD2 CAR T-cell therapy clinical trial but was not involved in this study. “This is a tumor for which nothing has ever worked. I think this is the start of a revolution in understanding how to treat these patients.”   
  • The Hill reported yesterday
    • “Broccoli sold at Walmart stores in 20 states has been recalled.
    • “Braga Fresh last week issued a voluntary and precautionary advisory for 12-ounce bags of Marketside Broccoli Florets that may be contaminated with Listeria monocytogenes.” * * *
    • “According to the U.S. Food and Drug Administration (FDA), which posted the advisory Tuesday, the pathogen can cause “serious and sometimes fatal infections” in young children, elderly people and others with weakened immune systems.” * * *
    • “It was distributed to stores in Alaska, Arkansas, Arizona, California, Colorado, Idaho, Illinois, Indiana, Kentucky, Louisiana, Michigan, Montana, Nevada, Ohio, Oklahoma, Oregon, Texas, Utah, Washington and Wyoming.
    • “No illnesses have yet been reported in connection with the product, the advisory said.”

From the U.S. healthcare business front,

  • Modern Healthcare reports,
    • “Sanford Health closed its merger with Marshfield Clinic Health System on Wednesday.
    • “The combined system, led by Sanford President and CEO Bill Gassen, has more than $10 billion in revenue and operates 56 hospitals across seven states, in addition to two health plans with roughly 425,000 members. It has almost 56,000 employees, including about 13,000 employees from Marshfield, according to a Thursday news release.“
  • and
    • “CareSource has completed its acquisition of Common Ground Healthcare Cooperative, the nonprofit health insurers announced in a news release Thursday.
    • “Privately held CareSource, which has 2 million Medicare, Medicaid and health insurance exchange members, gains 54,000 marketplace customers in Wisconsin through the deal. Common Ground CEO Cathy Mahaffey remains as chief executive of Common Ground Healthcare Cooperative and was named CareSource market president for the Badger State.”
    • “Common Ground had been one of three remaining member-owned cooperative health insurers supported with funding from the Affordable Care Act of 2010.” * * *\
    • “Of the 23 co-ops that debuted on the exchanges in 2013, only Community Health Options in Maine and Mountain Health CO-OP in Idaho, Montana and Wyoming are still in operation.”
  • Beckers Hospital Review lists “the hospitals patients are most likely to recommend in every state using Hospital Consumer Assessment of Healthcare Providers and Systems data from CMS.”
  • Beckers Payer Issues identifies the fifteen insurers exiting Medicare Advantage markets in 2025.
  • BioPharma Dive points out “ten clinical trials to watch in the first half of 2025. Expected readouts in diabetes, cancer and depression headline a series of study results that could help the biotechnology sector regain its footing after a shaky year.”
  • Forbes reports,
    • “The anti-obesity drug Zepbound made by Eli Lilly & Co. could be one of the biggest cost drivers for health insurers, employers and government health programs that cover it this year.
    • “Already, GLP-1 weight loss prescriptions Wegovy, Rybelsus and Saxenda—along with Ozempic—are the “single biggest driver” of employer health costs, adding 1% to the total premium expense for 2025, data released last fall from the benefits consultancy Aon said.
    • ‘These GLP-1 drugs are adding to general healthcare inflation that is projected to increase employer-sponsored health insurance coverage by 9%, eclipsing $16,000 per employee in 2025. The spike in premiums, which is higher than the 6.4% increase employers faced in 2024 and in 2023, comes before any “cost savings strategies” are implemented, Aon said.
    • “But a new report from GlobalData indicates Zepbound is poised to overtake other GLP-1 drugs.
    • “Zepbound’s superior efficacy and strategic market expansion suggest that the drug will dominate the obesity market, surpassing Novo Nordisk’s Wegovy (semaglutide),” GlobalData said in a report the market research firm released Tuesday.”
  • Per BioPharma Dive,
    • “Neumora Therapeutics, a well-funded biotechnology company, lost more than 80% of its value Thursday because its most advanced drug failed a major test.
    • “After seeing positive signs in a smaller study in 2023, Neumora pushed the drug into a trio of late-stage clinical trials to evaluate it as a treatment for the most common type of depression. The company just released data from the first of those trials, which found the drug no better than a placebo at alleviating depression.
  • and
    • “Pfizer won’t move forward with asking regulators to approve a gene therapy for hemophilia A and instead will hand back rights to development partner Sangamo Therapeutics in a blow to the California-based biotechnology company. In a Dec. 30 statement, Sangamo CEO Sandy Macrae said his company was “surprised and extremely disappointed” by Pfizer’s decision, which comes some five months after the treatment met its goal in a Phase 3 study of people with the inherited bleeding disorder. Sangamo plans to search for an “optimal path” forward, which could include partnering with another company. Pfizer has steadily retreated from gene therapy, although it sells a hemophilia B gene therapy called Beqvez that it obtained from Spark Therapeutics.”
  • and
    • “After many years of effort, Novartis has obtained positive results from a Phase 3 study for a form of its spinal muscular atrophy gene therapy Zolgensma that’s delivered via spinal injection rather than intravenous infusion. Data from the study, called Steer, showed treatment improved motor abilities in people with the neuromuscular disease who were two years of age or older and could still sit but had never walked independently. U.S. regulators suspended testing of the intrathecal formulation in late 2019 over safety concerns, but in August 2021 permitted Novartis to begin the Steer study. Novartis plans to share the new data with health authorities to support approval of the gene therapy in a broader range of people with spinal muscular atrophy.”

Monday report

David Ermer–Generative AI, Medical / Rx research, Mental health care, NIH, Obesity, OPM, SDOH, U.S. Healthcare–
Thanks to Justin Casey for sharing their work on Unsplash.

From Washington, DC

  • Per a press release,
    • “OPM joins the nation in mourning the passing of President Jimmy Carter. President Carter showed that public service isn’t just a line of work – it is life’s calling. From a young naval officer to a political leader, to leading as a humanitarian building homes and curing diseases, President Carter answered the call to public service. He set an example for every American to give back to their communities. He will truly be missed.” 
  • The Washington Post reports,
    • Memorial services for former president Jimmy Carter are expected to span several days and include public events in Atlanta and Washington.
    • Carter’s state funeral will be held Jan. 9 at 10 a.m. inside Washington National Cathedral after a procession from Georgia and a ceremony in which his body will lie in state in the U.S. Capitol, according to a news release from the Joint Task Force-National Capital Region.
    • “The 39th president will then be buried in a private ceremony in his hometown, Plains, Georgia.”
  • Govexec adds,
    • “President Biden issued an executive order on Monday to close federal agencies and offices next month in recognition of former President Jimmy Carter, who died Sunday at 100 in his home in Plains, Georgia.”
    • In accompanying guidance, Office of Personnel Management acting Director Rob Shriver said all federal employees would be excused from duty Jan. 9 “except those who, in the judgment of the head of the agency, cannot be excused for reasons of national security, defense, or other essential public business.” 
    • The day off applies to federal employees nationwide and will be treated like a holiday for purposes of pay and leave, the memorandum said.  

From the public health and medical research front,

  • The Wall Street Journal reports,
    • “When President Jimmy Carter was diagnosed in 2015 with cancer in his liver and brain, he said that he would like to see the last Guinea worm die before he did.
    • “That just about came true.
    • “There were 3.5 million cases of the parasitic worm disease in 1986, when the 39th U.S. president took up the cause of eradicating it. In 2023, there were 14 human cases, and 11 from January through early December 2024, according to a provisional count.
    • “We’re not there yet, but thanks to him we’re very close,” said Dr. Donald R. Hopkins, former vice president of health programs and now special adviser on Guinea worm eradication to the Carter Center, the human-rights nonprofit the former president founded in 1982 with his wife, Rosalynn Carter.”
  • The Washington Post reports,
    • “Cases of the illness known as norovirus — which induces miserable bouts of vomiting and diarrhea — are surging across the United States, according to the Centers for Disease Control and Prevention. Ninety-one outbreaks of the gastrointestinal bug were reported the week of Dec. 5, the latest period for which data is available. That’s 22 more outbreaks than in the last week of November.
    • “While sometimes referred to as the stomach flu, the disease is not caused by the influenza virus, which results in respiratory illness.
    • “There are about 2,500 reported outbreaks each year in the United States, happening most frequently between November and April. When new strains of norovirus emerge, case counts usually rise, according to disease trackers.
    • “This year, the number of reported norovirus outbreaks have exceeded the numbers that we’ve seen recently and in the years before the pandemic,” according to the CDC.”
    • The article delves into signs and symptoms, treatment options, etc.
  • The American Medical Association tells us what doctors wish their patients knew about depression.
  • Neurology Advisor adds, “One in 6 women experienced symptoms of postpartum depression 2 months after cesarean delivery, according to study findings published in the American Journal of Obstetrics and Gynecology.“
  • The Wall Street Journal tells us about a 24 year old man who is trying to “outrun” schizophrenia.
    • “For the past four years, Kevin has been part of a living experiment. Shortly after he began hallucinating, during his junior year at Syracuse University, his doctors recommended him for an intensive, government-funded program called OnTrackNY. It provided him with therapy, family counseling, vocational and educational assistance, medication management and a 24-hour hotline.
    • “Such programs — there are around 350 in the United States — challenge the old idea that psychotic disorders are degenerative, a long slide to permanent disability. They operate on the notion of a golden hour. By wrapping a young person in social supports early on, the theory goes, it may be possible to prevent the disorder from advancing.” * * *
    • “But now, after four years, his time in the program was up. An estimated 100,000 people experience a first episode of psychosis every year, roughly four times the number of spots available in early intervention programs. So in December, it would all go away: the team of five providers and the hotline and the therapist who reminded him of his mother.
    • “What would happen to him without their support? Even as enthusiasm for early intervention builds, long-term studies are casting doubt on whether its benefits last after discharge. For Kevin, leaving the program meant a sudden blast of autonomy and a million questions about what his future, with schizophrenia, would look like.
    • “The training wheels are coming off,” he said.”
  • Per MedPage Today,
    • “There was “low but improving uptake” of reporting about the diversity of participants in summary documents for FDA-cleared pulse oximeters after voluntary guidance was issued in 2013, an analysis of public FDA records found.” * * *
    • “The most important finding is that although there were more mentions of skin color descriptors in performance testing after the FDA’s guidance, a majority of the public clearance documents for pulse oximeters did not include any mention of testing in diverse individuals,” Ferryman told MedPage Today in an email.
    • “Clinicians who work in hospital settings often do not get to choose which pulse oximeter device they use with their patients,” Ferryman said. “Because this research is based on the public record, it suggests that even if clinicians wanted to do their own research on the performance of pulse oximeters across diverse populations, the majority of FDA-cleared device records do not include any information about testing in different skin tones.”
    • Pulse oximeter readings in patients with darker skin tones tend to overestimate oxygen saturation, a long-standing issue described in multiple studies and discussed by an FDA advisory committee. * * *
    • “Newer FDA guidance on pulse oximeter testing that’s under development may correct some of these problems, but no single change in guidance “is likely to be sufficient to fully correct the problems of development, marketing, and dissemination of fully equitable pulse oximeters,” the [researchers] wrote.”
  • Per National Institutes of Health press releases,
    • “A study of nearly 10,000 adolescents funded by the National Institutes of Health (NIH has identified distinct differences in the brain structures of those who used substances before age 15 compared to those who did not. Many of these structural brain differences appeared to exist in childhood before any substance use, suggesting they may play a role in the risk of substance use initiation later in life, in tandem with genetic, environmental, and other neurological factors.
    • “This adds to some emerging evidence that an individual’s brain structure, alongside their unique genetics, environmental exposures, and interactions among these factors, may impact their level of risk and resilience for substance use and addiction,” said Nora Volkow M.D., director of NIDA. “Understanding the complex interplay between the factors that contribute and that protect against drug use is crucial for informing effective prevention interventions and providing support for those who may be most vulnerable.”
    • “Among the 3,460 adolescents who initiated substances before age 15, most (90.2%) reported trying alcohol, with considerable overlap with nicotine and/or cannabis use; 61.5% and 52.4% of kids initiating nicotine and cannabis, respectively, also reported initiating alcohol. Substance initiation was associated with a variety of brain-wide (global) as well as more regional structural differences primarily involving the cortex, some of which were substance-specific. While these data could someday help inform clinical prevention strategies, the researchers emphasize that brain structure alone cannot predict substance use during adolescence, and that these data should not be used as a diagnostic tool.”
  • and
    • “Among people with dialysis-dependent kidney failure, a form of psychological therapy called pain coping skills training reduced how much pain got in the way of their daily lives, also known as pain interference. The clinical trial, funded by the National Institutes of Health (NIH), found that training people on how to manage pain reduced the extent to which pain affected their work and social activities, mood, and relationships. The pain coping skills training, which was adapted for people undergoing long-term dialysis, also improved other effects of pain, including the intensity of pain, depression, anxiety, and quality of life. Pain coping skills training is an approach widely used for chronic pain, but it had not previously been tested for people treated with dialysis.
    • “Very few interventions have been shown to improve the quality of life for people with end-stage kidney disease being treated with dialysis,” said Dr. Paul Kimmel, program director at NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which led the study. “For example, opioids, which have been a main treatment for pain in this population, have side effects that can be more pronounced in the presence of kidney failure, making pain management challenging.” * * *
    • “The study results indicate that pain coping skills training may be an appealing alternative or complement to pain medications. Although the effect of the pain coping skills training on the overall cohort was modest, its high acceptability, tolerability, and safety and its observed benefits to pain, anxiety, depression, and quality of life support further research on developing nonpharmacologic, non-invasive strategies for managing pain in dialysis populations.
    • “Future work will focus on how to prolong the favorable effects of pain coping skills training and how to broadly implement this intervention in clinical practice,” said lead author Dr. Laura M. Dember, nephrologist and clinical investigator at the University of Pennsylvania Perelman School of Medicine, Philadelphia. “Based on the successful results of this study, our hope is that this intervention can be made available broadly to patients receiving dialysis.”
  • The Wall Street Journal offers a quiz about the FDA’s latest guidance on whether a particular food is healthy. For what it’s worth, the FEHBlog scored 100.

From the U.S. healthcare business front,

  • Fierce Pharma offers a “2025 forecast: After Novo, Lilly expansion sprees, ‘positive signals’ emerge around future supply of GLP-1 drugs.”
  • The Washington Post informs us,
    • “They don’t get fruitcakes or Christmas cards from grateful patients, but for decades robots have been helping doctors perform gallbladder removals, hysterectomies, hernia repairs, prostate surgeries and more. While patients lie unconscious on the operating table, robotic arms and grippers work on their bodies at certain stages in these procedures ― all guided by doctors using joystick-like controllers, a process that minimizes human hand tremor.
    • “Now, a team of Johns Hopkins University and Stanford University researchers has reported a significant advance, training robots with videos to perform surgical tasks with the skill of human doctors.
    • “The robots learned to manipulate needles, tie knots and suture wounds on their own. Moreover, the trained robots went beyond mere imitation, correcting their own slip-ups without being told ― for example, picking up a dropped needle. Scientists have already begun the next stage of work: combining all of the different skills in full surgeries performed on animal cadavers.
    • “A new generation of more autonomous robots holds the potential to help address a serious shortage of surgeons in the United States, the researchers said.
  • Check this out!
    • “As 2025 nears, healthcare is undergoing unprecedented transformation, particularly with headlines about artificial intelligence (AI) technologies shifting away from grandiose promises as the dust starts to settle around the potential of Generative AI (GenAI). These innovations and others aim to reshape how healthcare is delivered. 
    • “To shed light on anticipated trends, challenges and opportunities in healthcare technology in 2025, leading experts from Wolters Kluwer Health offer their outlook on 2025 across a variety of topics. Diffusing the hype, the predictions offer an eye-opening look at what’s ahead and lead us toward a smarter, more resilient future in healthcare technology.” 

Midweek update

David Ermer–CMS, Congress, FDA, Generative AI, Medical / Rx research, Obesity, U.S. Healthcare, Uncategorized–

From Washington, DC,

  • The Wall Street Journal reports,
    • “President-elect Donald Trump said he opposes the bipartisan deal struck by congressional leaders to avoid a partial government shutdown this weekend, insisting that lawmakers tear up the agreement and pass a narrower bill.
    • “Trump’s comments upended efforts to pass a stopgap spending bill to keep the government funded through mid-March, while also providing more than $100 billion in disaster and farm aid. Trump said Congress should craft a new deal that keeps the aid but leaves out other measures, and couple that with immediately raising the federal debt ceiling, ahead of a deadline on the nation’s borrowing limit looming next year.” * * *
    • “To keep the government funded, a bill must pass both chambers of Congress and be signed into law by President Biden before Friday’s midnight deadline.” 
  • Politico identifies the winners and losers in Tuesday night’s CR, FYI.
  • Federal News Network tells us,
    • “The Senate passed a defense bill Wednesday that authorizes significant pay raises for junior enlisted service members, aims to counter China’s growing power and boosts overall military spending to $895 billion while also stripping coverage of transgender medical treatments for children of military members.
    • “The annual defense authorization bill usually gains strong bipartisan support and has not failed to pass Congress in nearly six decades, but the Pentagon policy measure in recent years has become a battleground for cultural issues. Republicans this year sought to tack on to the legislation priorities for social conservatives, contributing to a months-long negotiation over the bill and a falloff in support from Democrats.
    • “Still, the bill passed comfortably 85-14, sending it to President Joe Biden. Eleven senators who caucus with Democrats, as well as three Republicans, voted against the legislation.”
  • Modern Healthcare informs us,
    • “The House Bipartisan Task Force on Artificial Intelligence [AI] has issued a comprehensive report outlining policy recommendations for AI’s in healthcare.
    • “AI development in healthcare has outpaced regulation of the technology, leaving the industry to create its own guidelines. Congressional leaders from both the Senate and House of Representatives have conducted hearings to learn how insurers and providers use AI, but they have not passed significant legislation to regulate it. 
    • “A bipartisan group of 12 Republican and 12 Democratic lawmakers led by co-chairs Rep. Ted Lieu (D-Calif.) and Rep. Jay Obernolte (R-Calif.) authored the report. The task force, formed in February, looked at AI in healthcare along with several other industries.”
  • The American Hospital News lets us know
    • “The Centers for Medicare & Medicaid Services today announced Michigan, New York, Oklahoma and South Carolina state Medicaid agencies were selected to participate in its state-based Innovation in Behavioral Health Model. The eight-year IBH Model is intended to improve care quality and behavioral and physical health outcomes for Medicare- and Medicaid-enrolled adults with moderate to severe mental health conditions and substance use disorders. The pre-implementation period will begin Jan. 1, 2025, when states will begin to conduct outreach and recruit specialty behavioral health practices to participate in the model.”
  • Modern Healthcare points out,
    • “The U.S. spent $4.9 trillion on healthcare in 2023, a 7.5% increase from the prior year, according to a report the Centers for Medicare and Medicaid Services Office of the Actuary published in the journal Health Affairs on Wednesday.
    • “National health expenditures, including the public and private sectors, constituted 17.6% of gross domestic product last year. That’s slightly higher than 17.4% in 2022 and 17.5% in 2019 — prior to the COVID-19 pandemic — but lower than 19.5% in 2020 and 18.3% in 2021 amid the public health crisis.
    • “The Office of the Actuary, which is independent from CMS leadership, mainly attributes the growth in 2023 to greater utilization and intensity. Hospital care, physician and clinical services, and retail prescription drugs were the three biggest categories of higher spending.
    • ‘Expenditures increased at a greater rate last year than during the prior two years, when pandemic-era funding flexibilities began to expire, according to the actuaries. Healthcare expenditures rose 4.6% in 2022 and 4.2% in 2021 after spiking 10.4% in 2020 because of COVID-19.”

In Food and Drug Association News,

  • Per Cardiovascular Business,
    • “The U.S. Food and Drug Administration (FDA) has announced that Boston Scientific is recalling the catheters associated with its POLARx Cryoablation System due to a heightened risk of esophageal injury. The issue has been linked to seven patient injuries and four deaths.
    • “The POLARx Cryoablation System is designed to treat recurrent, symptomatic atrial fibrillation that does not respond to treatment from medical therapy alone. It gained FDA approval back in August 2023.
    • ‘The FDA has ruled that this is a Class I recall, which means it is associated with the highest possible risk level. However, this recall does not involve removing the devices from the market. Instead, Boston Scientific has updated the instructions for use and is urging customers to follow these updated instructions moving forward. 
    • “The recall includes both the POLARx and POLARx FIT cryoablation catheters.”
  • Per MedTech Dive,
    • “Boston Scientific has recalled a group of Accolade pacemakers because of a malfunction that can permanently put devices in safety mode, limiting functionality and preventing devices from properly treating patients. The Food and Drug Administration said devices that permanently enter safety mode must be replaced.
    • “The recall has been tied to two deaths. Boston Scientific did not specify the number of injuries in its December recall notice. The FDA posted an alert for the recall on Monday.
    • “The subset of affected Accolade devices includes Accolade, Proponent, Essentio and Altrua 2 standard life and extended life pacemakers, as well as Visionist and Valitude cardiac resynchronization therapy pacemakers, according to the FDA’s notice.”

From the public health and medical research front,

  • The Washington Post reports,
    • “An individual in Louisiana has the first severe illness caused by bird flu in the United States, federal health officials said Wednesday.
    • “The patient, who is hospitalized, had been in contact with sick and dead birds in backyard flocks on their property, the Centers for Disease Control and Prevention said. It’s the first case of H5N1 bird flu in the United States that has been linked to exposure to a backyard flock, and news of the infection comes the same day California officials declared a state of emergency to confront the outbreak spreading among dairy cows.” * * *
    • “Emma Herrock, a spokeswoman for the Louisiana Health Department, said in an emailed statement Wednesday the patient is over 65 and has underlying medical conditions. She declined to describe the person’s symptoms or severity of illness. Citing patient confidentiality, she said there would be no updates about the patient’s condition at this time.”
  • The New York Times adds,
    • “The virus, H5N1, cannot yet spread easily among people, and it still poses little danger to the average American. Pasteurized dairy products are still safe to consume.
    • “But the past few weeks have brought a steady drumbeat of cases in people, dairy cattle, birds and other animals. Each infection gives the virus a chance to take on a form that could cause a pandemic, experts warned.
    • “All these infections in so many species around us is paving a bigger and bigger runway for the virus to potentially evolve to infect humans better and transmit between humans,” said Dr. Nahid Bhadelia, the director of the Boston University Center on Emerging Infectious Diseases.
    • “That represents an escalation in the situation, even if risk to general population remains low,” she said.
    • “California has borne the brunt of the outbreak in cattle.
    • “The first herds in the nation infected with the bird flu virus, H5N1, were identified in March. California identified its first infected herd in late August.
    • “But since then, the state’s agriculture department has found the virus in 645 dairies, about half of them in the past 30 days alone.
    • “California has also recalled raw milk products from two companies after the virus was detected in samples.”
  • STAT News informs us,
    • “A major report on alcohol’s health effects — which will inform the 2025 Dietary Guidelines for Americans — found moderate drinkers had lower all-cause mortality, and a lower risk of death from cardiovascular disease, than those who never drank. The findings are sure to cause a stir, especially once a separate panel of experts releases its own alcohol report in coming weeks. 
    • “For years, researchers and public health officials have been taking a harder stance on alcohol as evidence has emerged of its associations with various diseases, including certain cancers and liver disease. The head of the National Institute on Alcohol Abuse and Alcoholism, George Koob, has said there are “no health benefits to alcohol.” The new 230-page report, released Tuesday by the National Academies of Sciences, Engineering, and Medicine, seems to undermine those assertions. 
    • “The “Review of Evidence on Alcohol and Health” from NASEM does not make recommendations. Instead, it summarizes the available evidence published in the past five to 15 years on how moderate alcohol consumption is linked to lactation, weight, cancer, cardiovascular disease, neurocognition and all-cause mortality. Moderate drinking is defined as two drinks per day for men, or one drink per day for women. The committee’s conclusions are based on associations, so the report doesn’t explain whether alcohol consumption is directly responsible for the outcomes. 
    • “Recommendations will be made by the main dietary guidelines committee next year, using NASEM’s review and another, from a separate panel in the Department of Health and Human Services. That report has not been released yet but is expected by next month.” 

From the U.S. healthcare business front,

  • Beckers Payer Issues names the “four health insurers earned a spot on the latest list of the 250 best-managed companies, as ranked by the Drucker Institute.”
  • BioPharma Dive reports,
    • “Merck & Co. has made its first big move in obesity treatment, announcing Wednesday it is paying Hansoh Pharma $112 million for rights outside China to a preclinical pill that works similarly to the popular injection Wegovy.
    • “Per deal terms, China-based Hansoh could receive up to $1.9 billion in additional payouts based on reaching clinical, regulatory and commercial milestones. Hansoh has an option to co-promote or solely commercialize the pill, code-named HS-10535, in China.
    • “Merck was one of the few big U.S. drugmakers that didn’t have an experimental obesity drug in development, and investors were therefore closely watching whether it would make a deal.”
  • Beckers Hospital Review ranks weight loss drugs by recent price changes for us.
  • Also, per BioPharma Dive,
    • “Almost 15 years ago, in the midst of an opioid epidemic that would kill more than half a million people in the U.S., a startup formed with the aim of creating new, non-addictive pain drugs.
    • “This goal could have been seen as noble. But for most investors, it was far too risky. Pain research was known to be exceedingly difficult and, even if successful, any resulting products would have to compete in a healthcare system that opioid makers had already gamed.
    • “The startup, SiteOne Therapeutics, has stayed afloat in the years since mostly through small grant funds. Yet, in a major reversal of fortune, it recently began to receive a huge influx of investment. The company on Wednesday announced the closing of a $100 million fundraising round,and plans to put the cash toward human studies designed to show its drugs work as intended.
    • “Pain has really been out of favor in the industry up until very recently,” said John Mulcahy, SiteOne’s cofounder and CEO. “Now is the time to add additional resources to really ramp things up.
    • “SiteOne’s research focuses on a kind of protein that’s embedded, by the thousands, in the perimeter of cells. Aptly named “ion channels,” these microscopic tunnels allow cells to communicate with one another through the rush of electrically charged particles. They are essential. Without them, our bodies wouldn’t be able to move muscles, sense surroundings or fight against germs.
    • “These functions also make ion channels attractive targets for drug researchers, who have already found ways to use them to combat seizures, infections, and problems with the heart and blood pressure. And over the past couple decades, technological advances have led to a better understanding of these proteins, such that some pharmaceutical companies now believe the field will, before too long, produce new treatments for pain, epilepsy, depression and many more neurological conditions.”

Monday Report

David Ermer–ACA, CDC, CMS, Congress, FDA, HSA, Medical / Rx research, Obesity, OPM, Rx coverage, Telehealth, U.S. Healthcare–
Photo by Sven Read on Unsplash

From Washington, DC

  • The Hill reports,
    • “Top Republicans are signaling progress in government funding talks as leaders look to clinch a deal ahead of a looming Friday deadline. 
    • “House Appropriations Chair Tom Cole (R-Okla.) told reporters Monday that the “differences are narrowing” between all sides as they try to hash out the last significant funding deal in the divided Congress.
    • “It’s both between the House and the Senate and Republicans and Democrats. So, they’re both institutional differences, and there are partisan differences,” Cole said. But he added “there are a lot fewer of them than there were 24 hours ago.” * * *
    • “Pressed about the status of health care as leaders look to tie up loose ends in the CR, House Majority Leader Steve Scalise (R-La.) said Monday there are “big discussions on all of the remaining items.”
    • “But we’re trying to get it wrapped up,” he said. 
    • “According to a source familiar, a package of key health policies is expected to be attached to the stopgap funding bill. It will likely include a two-year extension of telehealth flexibilities for Medicare, as well as an overhaul of pharmacy benefit managers’ business practices.” 
  • Fierce Healthcare adds,
    • “Pharmacy benefit manager reform is included in a larger-than-anticipated healthcare package, but the PBM lobby is fighting the legislation at the eleventh hour.
    • “Lawmakers appear to have agreed to a lame-duck healthcare package which, in addition to PBM reform, will include key program extensions.
    • “As of last weekend, the package included an increase to the Medicare physician fee schedule of 2.5% for one year, bonuses to alternative payment models and a reauthorization of the SUPPORT Act for dealing with the opioid crisis.
    • “PBM policies will be used as budgetary offsets. The legislation would ban spread pricing in Medicaid, ensure Part D plan sponsors delink PBM fees from the price of a drug and includes other transparency requirements.
    • “The end-of-year health care package accompanying the Continuing Resolution has morphed into a massive 400-page bill that includes provisions that would undermine the role that PBMs play in lowering costs and providing choices for employers in the prescription drug marketplace,” said the PBM trade lobby, the Pharmaceutical Care Management Association (PCMA), in a statement Dec. 16. “The health care provisions included in the latest draft, as reported in the media, risk increasing costs for health plan sponsors, like employers and labor unions, patients, and families, and hiking up premiums for seniors.”
  • One Digital informs us that “Congress passed the Paperwork Reduction Act and the Employer Reporting Improvement Act, each of which modify the ACA’s provisions on 1094 and 1095 tax form reporting. President Biden is expected to sign both acts into law, significantly altering ACA reporting requirements.”
    • “The Paperwork Reduction Act amends the ACA by no longer requiring employers and health insurance providers to send tax forms to the covered individuals under their health plan. Previously employers and/or insurance providers had to send 1095-B/1095-C tax form to each covered individual showing proof of minimum essential coverage. Now, those forms must only be sent when requested by the covered individual. If a covered individual requests a form, the form must be provided by January 31 or 30 days after the date of the request, whichever is later. Employers and insurance providers must inform covered individuals of their right to request a form.”
    • “The Employer Reporting Improvement Act codifies IRS regulations that allow for an individual’s date of birth to be substituted if the individual’s Tax Identification Number is not available. The Act also amends the ACA to incorporate IRS regulations allowing employers and insurance providers to offer 1095-B and 1095-C tax forms to individuals electronically.
    • Additionally, and more importantly to employers, the Act requires the IRS to give large employers at least 90 days to respond to 226-J letters that issue a proposed employer shared responsibility payment. Previously, employers had only 30 days to respond. Finally, the Act establishes a six-year statute of limitations for collecting these payments.”
       
  • The Plan Sponsor Council of America tells us,
    • “The ERISA Advisory Council (EAC) voted on and approved 12 recommendations for the Department of Labor (DOL) to improve health insurance claim denials and related appeals. These reforms range from better oversight of AI determinations to requiring payouts for prior approvals.
    • “Lisa Gomez, head of the Employee Benefit Security Administration (EBSA), described these proposed reforms today as “strangely and somewhat tragically timely, with the events of last week,” in reference to the killing of UnitedHealthcare CEO Brian Thompson in Manhattan on Dec. 4.”
    • Due to the Affordable Care Act, ERISA appeal procedure changes embedded in regulations typically apply to FEHB carriers.
  • The American Hospital Association News tells us,
    • “The Department of Health and Human Services Dec. 16 published a final rule implementing certain provisions related to information blocking exceptions. The rule revises defined terms related to protecting access to care for purposes of the information blocking regulations.
    • “The agency adopted select provisions first proposed in August as part of the much larger Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) rule. The adopted provisions are designed to address concerns from patients, health care providers and other stakeholders regarding patient privacy, access to care, preferences for electronic health information sharing, and methods for achieving a balance between certainty and flexibility for entities involved in enhancing EHI interoperability and exchange.
    • “The finalized “Protecting Care Access Exception” would allow entities to restrict EHI sharing under certain conditions to mitigate the risk of legal repercussions for patients, providers or care facilitators involved in lawful reproductive health services. The provisions will be effective immediately when published Dec. 17 in the Federal Register.
    • “This is the second rule in less than a week containing policies originally included in the proposed HTI-2 rule. As such, additional provisions of the HTI-2 rule, including prior authorization application programming interfaces, United States Core Data for Interoperability Version 4 standards and public health interoperability requirements — which are currently under review by the White House Office of Management and Budget — could be published soon.”
  • and
    • “The Centers for Medicare & Medicaid Services Dec. 15 announced an extension to Dec. 18 for enrollment in federally facilitated marketplace coverage that begins Jan. 1. This applies to the 31 states that use HealthCare.gov for signups. Those consumers previously had until Dec. 15 to enroll for a full year of coverage. Individuals who enroll for 2025 coverage after Dec. 18 will have their plans begin Feb. 1. Individuals in Washington, D.C., and the 19 states that operate their own state-based marketplaces are advised to visit their state website for deadlines and effective dates for their coverage.”
  • and
    • “The Health Resources and Services Administration last week directed Sanofi to cease implementation of its 340B rebate proposal immediately and to inform HRSA of its plans no later than Dec. 20 in order to provide adequate notice to covered entities.
    • “By way of this correspondence, HRSA provides warning that this unapproved credit proposal violates Sanofi’s obligations under the 340B statute, and HRSA expects Sanofi to cease implementation of it,” wrote HRSA Administrator Carole Johnson.
    • “The letter says that the proposal, if implemented, would violate Sanofi’s obligations under the 340B statute and subject Sanofi to potential consequences, such as termination of Sanofi’s Pharmaceutical Pricing Agreement and civil monetary penalties.
    • “In its Nov. 22 letter to 340B covered entities, Sanofi said it would be effectuating 340B discounts via the new credit model as of Jan. 6, 2025, for disproportionate share hospitals, critical access hospitals, rural referral centers and sole community hospitals.”
  • Govexec points out,
    • “The Office of Personnel Management is set to publish a final rule Tuesday that would finally implement provisions of a seven-year-old law aimed at reducing agencies’ ability to put federal workers accused of misconduct on prolonged stints of administrative leave.
    • “In 2016, Congress enacted the Administrative Leave Act as part of the 2017 National Defense Authorization Act. The law tries to reduce agencies’ reliance on placing federal workers who are under investigation into employment limbo—paid but unable to work—for long stretches of time. It also updated the government’s policies on weather and safety leave.
    • “Though OPM proposed regulations to implement all of the law’s provisions in 2017, only the provisions governing weather and safety leave actually made it across the finish line. But earlier this year, the environmental advocacy group Public Employees for Environmental Responsibility sued the HR agency seeking to force it to act.
    • “In a final rule set for publication Tuesday in the Federal Register, OPM formally implemented the 2016 law’s restrictions on administrative leave. While the new rule will be effective Jan. 17, 2025, agencies have until October to comply with the new restrictions on administrative leave.”

In Food and Drug Administration news,

  • MedTech Dive relates
    • Zimmer Biomet received Food and Drug Administration clearance for a new stemless shoulder implant, called Osseofit.
    • The implant is shaped to match the anatomy of patients’ humerus, or upper shoulder bone, while preserving as much of their healthy bone as possible in total shoulder replacement procedures. Zimmer announced the clearance on Friday.
    • CEO Ivan Tornos highlighted stemless shoulder implants as a meaningful growth driver for the orthopedics company in an Oct. 30 investor call.
  • Per Fierce Pharma
    • “The FDA has blessed two previously approved medicines—one a cream and the other an injection—to treat atopic dermatitis (AD). Both products now will be available to a significantly larger patient population as roughly 26 million in the U.S. have the disorder, which is also known as eczema.
    • “Organon’s Vtama, a topical cream originally approved for plaque psoriasis in 2022, is now cleared to treat AD, the company said early Monday. The nod came three months after New Jersey-based Organon acquired the product in a $1.2 billion takeover of Dermavant. 
    • “Similarly, the FDA gave a thumbs-up to Galderma’s Nemluvio to treat AD. The drug, a monthly subcutaneous injection, was previously endorsed by the U.S. regulator for prurigo nodularis.” 
  • and
    • “After seven decades with no advances in the treatment of the genetic disorder classic congenital adrenal hyperplasia (CAH), Neurocrine Biosciences has scored FDA approval for its first-in-class, twice-daily oral medicine Crenessity (crinecerfont).
    • “The blessing came nearly two weeks before its FDA target date and is termed as “paradigm shifting” by the San Diego-based company. The selective oral corticotropin-releasing factor type 1 receptor (CRF) antagonist can be used by CAH patients ages 4 and older.
    • “Serving as an add-on to glucocorticoid replacement therapies, Crenessity reduces excess adrenocorticotropic hormone (ACTH) and downstream adrenal androgen production, allowing for glucocorticoid dose reduction.”
  • Cardiovascular Business alerts us,
    • “The U.S. Food and Drug Administration (FDA) and Boston Scientific today sent an urgent alert to patients and healthcare providers about the potential need for early device replacement of some Accolade pacemakers.
    • The company announced a recall for a subset of its Accolade devices because of an increased risk of permanently entering the safety mode. This has limited functionality, making the device unable to properly regulate the heart’s rhythm and rate. Most of the activations have occurred during follow-up office or hospital visits when the devices are interrogated for data.
    • There have been two reported patient deaths in pacemaker dependent patients after the devices went into safety mode in an ambulatory outpatient medical setting. Boston Scientific said about 70% of safety mode events occurred during in-office interrogations from a Latitude programmer, and the remaining incidents took place in an ambulatory setting.
    • “The risk of harm may be greater when safety mode occurs in an ambulatory setting, as patients are not in a monitored clinical environment,” the company said in its recall notice.
  • Beckers Hospital Review adds,
    • “The FDA has recalled more than 233,000 bottles of antidepressant duloxetine, sold by Rising Pharmaceuticals, due to a potential cancer risk. 
    • “The recall, issued Dec. 5, was prompted by the discovery of a nitrosamine impurity, N-nitroso-duloxetine in the capsules which exceeds the FDA’s safety threshold. 
    • ‘The FDA has classified the recall as a Class II risk, its second most severe classification. The recall affects 233,000 bottles of duloxetine, which is used to treat conditions such as depression and generalized anxiety disorder. 
    • “The FDA also recalled 7,107 bottles of duloxetine capsules distributed by Towa Pharmaceutical Europe in October for similar concerns about nitrosamine impurities.” 

From the public health and medical research front,

  • MedPage Today reports,
    • “CDC could not confirm what was suspected to have been the first H5N1 bird flu case linked to raw milk.
    • “The patient, a child in Marin County, California, experienced fever and vomiting after drinking raw milk, as reported last week. The child initially tested positive for influenza A, with the local lab unable to find evidence of person-to person transmission between the child and her family members.
    • “The State Laboratory and the CDC conducted additional testing, “but due to low levels of viral RNA, they were unable to confirm whether the influenza A virus present was H5N1 (avian influenza) or seasonal influenza,” according to the Marin County public health department.”
  • The Washington Post tells us,
    • “Nearly a quarter of U.S. adults reported living with chronic pain in 2023, according to a recent report from the Centers for Disease Control and Prevention.
    • “Just over 24 percent (24.3 percent) of survey respondents said they experienced chronic pain either most days or every day, the CDC said, and nearly 9 percent of adults had “high-impact chronic pain” in the previous three months, meaning their pain frequently limited their life or work activities.” * * *
    • “Chronic pain and pain that often restricts life or work activities, referred to in this report as high-impact chronic pain are the most common reasons adults seek medical care, and are associated with decreased quality of life, opioid misuse, increased anxiety and depression, and unmet mental health needs,” co-authors Jacqueline W. Lucas and Inderbir Sohi wrote in a data brief on the numbers.”
  • Beckers Hospital Review adds,
    • “In 2023, the United States saw a slight decrease in obesity prevalence among adults, according to research findings published Dec. 13 in JAMA. 
    • “Amid projections of increasing obesity rates over the next decade, researchers from Boston Children’s Hospital and Optum Life Sciences analyzed body mass index data from 2013 to 2023. The dataset included nearly 48 million BMI measurements from 16.7 million nonpregnant adults. 
    • “Between 2013 and 2022, mean population BMI and obesity rates rose annually. Both figures slightly declined in 2023, the study found. 
    • “The researchers suggested this change could be due to weight loss GLP-1s such as semaglutide (Wegovy) and “pandemic-associated demographic and behavior changes.”
  • A recent National Health Statistics Reports shares characteristics of older Americans who fulfilled physical activity guidelines in 2022.
  • The American Medical Association lets us know what doctors wish their patients knew about hand, foot, and mouth disease.
  • MedPage Today notes,
    • “Diets higher in inflammatory foods were tied to an increased incidence of dementia in older adults, longitudinal data from the Framingham Heart Study Offspring cohort showed.
    • “Over 13 years of follow-up, higher Dietary Inflammatory Index (DII) scores averaged across three time points were linearly associated with an increased incidence of all-cause dementia (HR 1.21, 95% CI 1.10-1.33, P<0.001), reported Debora Melo van Lent, PhD, of UT Health San Antonio in Texas, and co-authors.
    • “Similarly, higher DII scores were linearly associated with an increase in Alzheimer’s disease dementia (HR 1.20, 95% CI 1.07-1.34, P=0.002), the researchers reported in Alzheimer’s & Dementia. Findings were adjusted for demographic, lifestyle, and clinical covariates.
    • “Although these promising findings need to be replicated and further validated, our results suggest that diets that correlate with low DII scores may prevent late-life dementia,” van Lent and colleagues noted.”
  • To that end, Consumer Reports, writing in the Washington Post, discusses “four ways to reduce inflammation for better health. It’s thought to be an underlying cause of diabetes, heart disease and more. Diet and lifestyle can help you control it.”
  • Per a press release,
    • “The Institute for Clinical and Economic Review (ICER) today released a Final Evidence Report assessing the comparative clinical effectiveness of tabelecleucel (“tab-cel”®, Pierre Fabre) for the treatment of Epstein-Barr virus positive post-transplant lymphoproliferative disease (EBV+ PTLD).
    • “ICER’s report on this therapy was the subject of the November 2024 public meeting of the New England CEPAC, one of ICER’s three independent evidence appraisal committees. 
    • “Downloads: Final Evidence Report | Report-at-a-Glance | Policy Recommendations 
  • STAT News reports,
    • “Just over a year ago the PREVENT calculator to predict cardiovascular risk was released by the American Heart Association. It was acclaimed for improving on a 2013 model that didn’t take into account companion conditions such as kidney disease or type 2 diabetes, or include people from more diverse backgrounds.
    • “PREVENT soon drew attention for its potential to reduce the number of Americans eligible to receive widely prescribed cholesterol-lowering statins, projected in two analyses published in June and July. 
    • “A less noted change was the addition of heart failure to conditions estimated by the risk calculator, alongside the traditional targets of heart attack and stroke. Heart failure is a serious illness that means the heart can no longer pump blood through the body as well as it should. It’s different from diseases that narrow blood vessels that feed the heart or brain.
    • “Heart failure has no cure, making it more urgent to identify who’s at risk. PREVENT allows that risk to be estimated using information typically collected in a regular primary care visit.”

From the U.S. healthcare business front,

  • Reuters reports,
    • “Powerful weight-loss drugs are expanding use of U.S. health care as patients starting prescriptions are diagnosed with obesity-related conditions or take the drugs to become eligible for other services, health records and discussions with doctors show.
    • “An exclusive analysis of hundreds of thousands of electronic patient records by health data firm Truveta found slight, but measurable, increases in first-time diagnoses of sleep apnea, cardiovascular disease, and type 2 diabetes within 15 days of an initial prescription for a GLP-1 weight-loss drug between 2020 and 2024.
    • “In addition to obesity-related conditions, some patients are being prescribed the drugs to lose weight and become eligible for services, including organ transplants, fertility treatments or knee replacements, according to interviews with seven doctors and five other health experts.
    • “This is a population that previously felt stigmatized by health care providers and often didn’t return. But now that they’re actually seeing themselves get healthier, asking clinicians questions and engaging more, I do think we’re seeing new patients,” said Dr. Rekha Kumar, a New York endocrinologist and obesity medicine specialist.”
  • McKinsey and Company explore how the healthcare industry can weather current challenges.
    • “The healthcare industry has been buffeted by a growing number of challenges over the past few years. This turbulence struck provider organizations in 2022, while payers were initially sheltered from the storm (Exhibit 1). But conditions became more difficult for payers in 2023, which has continued into this year, and there’s limited respite on the horizon. Unlike the widespread challenges the provider and payer sectors have faced, the picture for pharmacy services has been more nuanced. Some organizations have been propelled by tailwinds from pharmaceutical innovation and new delivery models, while others have battled headwinds from increased regulatory scrutiny. The healthcare services and technology (HST) sector, in contrast, has benefited from continued demand for data, analytics, and software. Along with pressures on earnings, the healthcare sector has also faced challenges in the capital markets, with deal activity in 2024 lower than 2023, according to McKinsey analysis.”
  • Per the American Hospital Association News,
  • Healthcare IT News tells us “74% of hospital leaders say virtual nursing will become integral to acute care. A nurse expert [in the article] discusses the results of a new survey from AvaSure showing that, while virtual nursing has yet to gain traction in acute inpatient care, it holds much promise – and already is showing results that benefit both nurses and the bottom line.”
  • A recent National Health Statistics Report examines under age 65 enrollment in high deductible and consumer driven health plans in the U.S.
  • Per HR Brew,
    • “Despite a softening job market, US employers are expected to grant merit increases of 3.3% to non-unionized employees in 2025—the same rate as this year, according to a report by Mercer.
    • “It’s not surprising to us to see employers really kind of keeping up with the part of what they had done in the prior year,” said Jack Jones, principal consultant at Mercer. “I think what it shows is employers are still prioritizing the investment in their talent.”
    • “Next year, employers are expected to increase their total salary budgets—which includes money for promotions and adjustments to reach equity—to 3.7%, excluding unionized workers. The increase was 3.6% for this year. About one-tenth (9.3%) of employees are expected to receive promotions next year, compared to 8% in 2024.
    • “However, Jones noted the numbers could change because only 20% of the more than 850 organizations surveyed had finalized their budgets. Still, most organizations (69%) don’t expect to adjust their initial projections.”

Thursday Report

David Ermer–Congress, FDA, Federal employment benefits, Medical / Rx research, Mental health care, NIH, Obesity, Rx coverage, U.S. Healthcare, Uncategorized–
Photo by Josh Mills on Unsplash

From Washington, DC

  • Govexec tells us,
    • “Senate Majority Leader Chuck Schumer told unions and federal employee groups Wednesday that he will schedule a vote on the Senate floor on legislation to repeal two controversial tax provisions that reduce some public servants’ retirement benefits just weeks before the end of the congressional session and Democrats’ control of the chamber.
    • “Schumer’s remarks came at a rain-soaked rally, organized by lawmakers and organized labor on Capitol Hill in support of the Social Security Fairness Act (H.R. 82), which passed the House by a 327-75 vote last month.” * * *
    • “If enacted, the legislation would repeal Social Security’s windfall elimination provision and government pension offset. The windfall elimination provision reduces the Social Security benefits of retired federal employees who spent a portion of their careers in the private sector in addition to a federal, state or local government job where Social Security is not intended as an element of their retirement income, such as the Civil Service Retirement System. And the government pension offset reduces spousal and survivor Social Security benefits in families with retired government workers.”
  • FedSmith adds,
    • “The OPM retirement backlog has dropped to levels not seen since 2016. As of the end of November 2024, the total outstanding retirement claims at the Office of Personnel Management is 13,844. The last time it was at or below that level was June 2016 when it was 13,529.
    • “OPM received 6,808 new retirement claims in November and processed 7,872. It took an average of 55 days to process claims.
    • “So far in 2024, the average level of the OPM retirement backlog is 16,083. The average number of retirement claims submitted by federal employees to OPM each month has been 7,558, and the average number processed each month is 7,599.
    • “The end of a year is the peak time for federal employees to retire, so it’s good news for federal employees who plan to retire soon that the number of pending retirement claims at OPM has fallen as the end of 2024 approaches.
    • “However, even though most federal employees retire at the end of a calendar year, the impact on the processing doesn’t hit until January. The peak time at OPM for processing retirement claims is January through March, and January is typically the month with the largest spike in the retirement backlog based on past data. For example, the OPM retirement backlog grew by 46% last January.”
  • BioPharma Dive lets us know,
    • “When the Food and Drug Administration took Eli Lilly’s Zepbound and Mounjaro off of its drug shortage list in October, companies making cheap “compounded” versions found themselves in a bind.
    • “By ending compounders’ ability to manufacture and sell their off-brand versions in bulk, the FDA’s decision also left some patients wondering how they would be able to access the popular obesity and diabetes drugs at an affordable price. About 12% of American adults have taken a GLP-1 medication, according to a May poll from KFF Health. And compounded versions may account for as much as 20% of all GLP-1 prescriptions, CNN reported.
    • “But when the FDA backed down, letting compound pharmacies resume their activities for the time being, the industry was left in something of a limbo. * * *
    • “The FDA said it will issue another update Dec. 19, although it’s possible it will be another extension of the review. The agency said in a late November joint status update to a court hearing the compounders’ challenge that it had not yet made a determination, according to Beaver.
    • “In the interim period, FDA has indicated it does not intend to take enforcement action against the continued compounding of tirzepatide,” Beaver said.
    • “With a new presidential administration set to take over next month, the FDA may simply wait.”
  • STAT News adds,
    • “Eli Lilly, which has been directing patients to various telehealth sites as it sells its blockbuster obesity medication Zepbound, is broadening its reach, announcing a partnership Wednesday with major telehealth platform Ro.
    • “Under the new agreement, Ro patients who are prescribed Zepbound will be able to get vials of the drug through its app. Previously, Lilly had only made these vials, which are priced lower than its injectable pens, available to patients who filled prescriptions through an online portal created by Lilly, called LillyDirect.”
  • MedTech Dive offers “four takeaways from the FDA’s first digital health advisory committee. Industry and patient representatives debated how the FDA should regulate generative AI in medical devices and address new challenges with the technology.”

From the judicial front,

  • Reuters informs us,
    • “The U.S. Department of Health and Human Services overstepped its authority when it boosted Medicare reimbursements to hospitals in low-wage areas to help them recruit and retain staff, a divided federal appeals court ruled on Wednesday.
    • “A 2-1 panel of the San Francisco-based 9th U.S. Circuit Court of Appeals found that HHS’s 2020 policy shift ran afoul of the law governing Medicare, the federal health insurance program for seniors and some people with disabilities.
    • “The decision was a victory for a group of 53 California hospitals that sued HHS in 2020 in Los Angeles federal court, saying their Medicare reimbursements were cut by a total of about $3.8 million to make up for the increased payments to hospitals in low-wage areas.
    • “HHS said earlier this year that it would not continue the policy in 2025, meaning that Wednesday’s decision will affect only reimbursements for past years going back to 2020.”

From the public health and medical research front,

  • The Wall Street Journal reports,
    • “When a woman learns she has breast cancer, her reaction is often: take it out. Now doctors say that might not always be necessary.
    • “Some women with the earliest stages of breast cancer could be carefully monitored, undergoing surgery and radiation only if the disease advances, new data suggests.
    • “The strategy is akin to one already used in early prostate cancer, as doctors are increasingly looking at whether they can pull back on some cancer therapies, to spare patients side effects and costs.
    • “This is really the first study to confirm our suspicions that there’s a subset of low-risk patients that could do just as well without surgery,” said Dr. Nancy Chan, a breast-cancer specialist at NYU Langone’s Perlmutter Cancer Center, who wasn’t involved in the study. “It’s really encouraging.” * * *
    • “It was a data-free zone because we already treated it like a cancer,” said Dr. E. Shelley Hwang, a breast-cancer surgeon at Duke Cancer Institute, who led the trial. “We didn’t know what we could dial back on.”
    • Hwang and her colleagues recruited some 950 women ages 40 and older with a type of low-risk DCIS that is sensitive to hormones. The women were split into two groups: One was recommended standard care—surgery with or without radiation—while the other was recommended mammograms every six months. The monitoring group could opt for surgery at any time and had to get surgery if the disease progressed.
    • Most women in both groups took hormone therapy to help keep cancer growth in check. Some 17% of women in the monitoring group ended up getting surgery, and some assigned to the treatment group declined to get an operation.
    • Two years later, the rates of women who developed invasive breast cancer were similar between the groups, less than 10%, the researchers found. The women also reported comparable rates of anxiety, a concern when doctors are considering dialing-back treatment.
    • Women who got standard care reported more arm problems and breast pain, but that resolved over time. The results were published in the academic journals JAMA and JAMA Oncology and presented at the San Antonio Breast Cancer Symposium on Thursday.
  • STAT News points out,
    • “Pfizer said Thursday its drug Ibrance showed efficacy in a group of breast cancer patients who do not currently have access to the medicine, potentially expanding its use.
    • “Ibrance, which generates annual sales of $4.3 billion, is currently used for patients whose tumors are positive for the estrogen receptor (ER) and negative for a second biomarker, called HER2. That population represents 70% of women with breast cancer. But the new results are in patients whose tumors test positive for both the estrogen receptor and HER2, a population that represents 10% of breast cancer patients.”
  • The New York Times relates,
    • “Over the last 20 years, clinicians have increasingly recognized that A.D.H.D. symptoms, which begin in childhood, can linger into adulthood, and that some groups — like women and people of color— are more likely to be underdiagnosed early in life. Now, with the rise of telemedicine, increased awareness of A.D.H.D. and changing attitudes about mental health treatment, new A.D.H.D. diagnoses are surging among older Americans.
    • “An analysis by Truveta, a health care data and analytics company, shows that the rate of first-time A.D.H.D. diagnoses has been on the rise since 2021, but the increase has occurred only among people 30 and older. From January 2021 to October 2024, the rate of first-time diagnoses rose about 61 percent among those ages 30 to 44 and 64 percent among those ages 45 to 64.
    • “As a result, about 31 percent of first-time diagnoses are now among people ages 30 to 44, the largest proportion of any age group. (In 2018, younger adults took the top spot.)
    • “The analysis, which was done at the request of The New York Times, drew on Truveta’s database of 30 health systems, which included more than one million people who had received first-time A.D.H.D. diagnoses.”
  • The National Institutes of Health Director, Dr. Monica Bertagnolli, writes,
    • “In people with brain tumors known as diffuse gliomas, cancerous cells often spread and invade nearby tissue to mix with healthy cells. As a result, it can be challenging for neurosurgeons to differentiate cancerous from healthy tissue during surgery as is required to safely remove as much of the cancer as possible. Many patients with glioma are found to have residual tumor after surgery, which can mean additional surgeries, earlier recurrence, and decreased survival. But research is showing that artificial intelligence (AI) tools could enable doctors to not only predict if a cancer will respond to treatment, but also to differentiate cancerous from healthy tissue rapidly enough to guide more brain surgeries in real time.
    • “In one promising example of this, an NIH-supported study in Nature  recently reported the development of an open-source, AI-based diagnostic system that can determine in just 10 seconds if part of a cancerous brain tumor that could be removed still remains. The new system, called FastGlioma, combines rapid, user-friendly, optical microscopy with AI models trained on diverse data, including over 11,000 surgical specimens and 4 million microscopy images, to give surgeons needed answers very quickly.
    • “Today, neurosurgical teams locate residual tumor during surgery guided by MRI or fluorescent imaging. The research team for this study—led by Todd Hollon , University of Michigan Health, Ann Arbor, and Shawn Hervey-Jumper , University of California, San Francisco—reports that the new system significantly outperforms current methods for identifying tumor remains, working faster and more accurately.” * * *
    • “The presence of residual tumor tissue following surgery is a significant and costly public health problem in the U.S. and around the world, for brain cancers and other solid cancers alike. The research team reports that FastGlioma can already accurately detect residual tumor in many other brain cancer types, including both adult and childhood brain cancers, suggesting it has potential to one day serve as a general-purpose tool for guiding brain tumor surgeries. The researchers also plan to explore the system’s application to other cancers, including lung, prostate, breast, and head and neck cancers. Through this kind of work, the researchers hope this tool and others like it can help unlock the potential of AI for improving cancer care in the years ahead.”
  • Per MedPage Today,
    • “Postmarketing data on obeticholic acid (Ocaliva) identified a risk for serious liver injury in primary biliary cholangitis (PBC) patients without cirrhosis, the FDA said in a safety communication on Thursday.
    • “The agency’s review of a mandated clinical trial “found that some cases of liver injury in patients without cirrhosis resulted in liver transplant. This risk was notably higher for patients taking Ocaliva compared with a placebo,” the FDA said.”
  • Per Beckers Hospital Review,
    • “The FDA has placed a hold on all clinical studies of vaccines for respiratory syncytial virus in infants due to safety concerns following a trial involving two mRNA-based vaccine candidates from Moderna. 
    • “A briefing document released by the FDA ahead of the Vaccine and Related Biological Products Advisory Committee revealed that a phase 1 trial evaluating two RSV vaccines in infants aged 5 to 8 months was paused in July after five severe cases of RSV-related illness were reported among infants receiving the vaccine candidates.” * * *
    • “VRBPAC will review the safety data and discuss implications for the future development of RSV vaccines for infants Dec. 12.” 

From the U.S. healthcare business front,

  • Per a press release,
    • The Institute for Clinical and Economic Review (ICER) today published its latest report on Unsupported Price Increases (UPI) of prescription drugs in the United States, highlighting the top 10 drugs with substantial net price increases in 2023. ICER determined that five of those drugs lacked adequate evidence to support any price increase, which resulted in a total of $815 million incremental added costs to US payers in 2023. The five drugs with unsupported price increases are Biktarvy, Darzalex, Entresto, Cabometyx, and Xeljanz.
    • Downloads: Final Report
    • “We continue to see list price increases that are far above the rate of inflation for many of the costliest drugs,” stated Foluso Agboola, MBBS, MPH, ICER’s Vice President of Research. “These price hikes resulted in over $800 million in excess costs to the US health care system in just one year alone. This impacts everyone in the country, especially patients and their families. Over the past few years, ICER has played a role in highlighting substantial price increases. Since launching this report in 2019, we have noticed a decrease in the number of drugs that have significant price hikes without any new clinical evidence. In this report, half of the drugs we assessed had price increases in the setting of new evidence of additional benefits or reduced harm, while the other half lacked such evidence to support their higher price tag.”
  • STAT News discusses “AI versus AI: The emerging arms race over health insurance denials. New startups are harnessing artificial intelligence to appeal denials by health insurers.
    • “Like many Americans, Holden Karau said she was fed up with health insurance. * * *
    • Karau’s company, FightHealthInsurance.com, is one of many upstart businesses seeking to harness the power of artificial intelligence to combat denials by health insurers that block access to medical services.
    • “There’s a lot of technology on the insurance side to automate denials,” Karau said. “I think it’s time to build the tools for patients and providers.”
    • “Her company, and its companions in the market, are just getting off the ground. But they promise to help automate appeals for providers and patients, making it much faster and easier to contest denials that often go unchallenged.”
  • Beckers Hospital Review shares weight loss drug fills by states.
    • “Alaska recorded the highest percentage of medication fills for weight loss drugs this year, according to data from GoodRx. 
    • “To assess state-level trends, GoodRx examined fill rates for all medications, excluding vaccines, from a nationally representative sample between Jan. 1 and Oct. 31. The figures below reflect the percentage of total medication fills for GIP and GLP-1 drugs prescribed for either diabetes or weight loss indications. Medications for Type 2 diabetes included Ozempic, Mounjaro, Victoza and liraglutide, while medications prescribed for weight loss included Wegovy, Zepbound, Saxenda, Qsymia and phentermine.
    • “Regionally, states in the South had higher fill rates for medications prescribed for diabetes while states in the Northeast had the highest fill rates for medications prescribed for weight loss.” 
  • and points out “US News’ 118 maternity care access hospitals.”
    • “On Dec. 10, U.S. News & World Report released its annual Best Hospitals for Maternity Care ratings, which also recognize hospitals providing services to underserved communities.
    • “U.S. News identified 118 hospitals as Maternity Care Access Hospitals for providing maternity services in areas that would otherwise lack access to such care.
    • “To qualify, these hospitals met specific geographic and quality criteria. They were eligible if they were the only hospital providing maternity care within their county, and the county had fewer than 60 obstetric providers per 10,000 births. Alternatively, hospitals qualified if they were the only facility within a 15-mile radius and were located in a county with fewer than 128 obstetric providers per 10,000 births.”
  • Per Fierce Healthcare,
    • “Centene released its earnings guidance for 2025 as a part of its investor day on Thursday.
    • “The health insurer expects to bring in between $166.5 billion and $169.5 billion in revenue for the year, including between $154 billion and $156 billion in premium and service revenue, according to the announcement. It also estimates earnings per share of at least $7.25 in 2025.
    • “The company is bracing for elevated utilization trends to continue as well, according to the announcement. It projects a medical loss ratio of between 88.4% and 89%.”

Weekend update

David Ermer–CDC, Congress, Federal employment benefits, Medical / Rx research, Obesity, OPM, U.S. Healthcare, Uncategorized–
  • The Wall Street Journal reports
    • “Days after a hooded and masked man fatally shot a UnitedHealthcare executive in Manhattan, investigators have learned key details about the gunman’s stay in the city and how he planned his crime.
    • “Investigators are looking at the possibility that the shooter might be a disgruntled ex-employee of Brian Thompson’s insurance company or an angry client, according to NYPD Chief of Detectives Joseph Kenny. Investigators have been in touch with Thompson’s family, but there is no indication the shooting involved his private life, police said.
    • “New York Mayor Eric Adams told reporters Saturday that police have a name for the suspect but declined to disclose it pending the investigation. “The net is tightening,” the mayor said outside a Police Athletic League event in Harlem, according to footage from MSNBC. A New York police spokesman late Saturday said he couldn’t confirm that the department has the name of a suspect.
    • “The shooter might have used a large handgun, or possibly a veterinary gun, a firearm used to put down animals that doesn’t make a lot of noise, police said.
    • “The assailant likely left New York on a bus early Wednesday, not long after he fatally shot Thompson outside a hotel in Midtown Manhattan, investigators said. But he left behind a critical piece of evidence: the backpack he wore during the shooting and apparently abandoned in Central Park. Police found a bag there Friday afternoon.

From Washington, DC,

  • OPM reminds us,
    • “OPM has extended Open Season for the Postal Service Health Benefits Program through Friday, December 13th at 11:59 pm EST. This extension is only for the PSHBP. This does not extend to FEHB or other benefits programs. The deadline for FEHB remains 11:59 pm, in the location of your electronic enrollment system, on Monday, December 9th.”
  • Federal News Network tells us,
    • “Office of Personnel Management Acting Director Rob Shriver sees several areas of opportunity to build on the forward momentum to reform federal hiring and retention.
    • “During the Biden administration, the President’s Management Agenda focused one of its key priorities on strengthening and empowering the federal workforce. Though the efforts of the PMA are now coming to a close, administration officials pointed to promising signs of an improving federal hiring process.
    • “For example, the Biden administration has taken steps to keep the ball rolling on a push toward skills-based hiring. In April, the White House announced plans to transition the government’s primary job series for federal IT specialists away from college degree requirements over the next year.
    • “This really picked up on an initiative from the prior administration, and we’ve been grinding through the implementation of that,” Shriver said in an interview with Federal News Network at a Dec. 4 White House event. “But there are also a lot of challenges to implementing true skills-based hiring.”

From the public health and medical research front,

  • Cardiovascular Business informs us,
    • “Heart surgeons with the WVU Heart and Vascular Institute have made a bit of history, performing the world’s first combined robotic aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) procedure—all through one small incision. Patients requiring these procedures typically undergo open-heart surgery. 
    • “The patient in question, 73-year-old Poppy McGee, presented with a history of stroke, brain surgery and ongoing weight loss. She was referred to Vinay Badhwar, MD, executive chair of the WVU Heart and Vascular Institute and chair of WVU’s department of cardiovascular and thoracic surgery, who initially recommended open-heart surgery. However, when McGee and her family heard that the odds of dying exceeded 10%, they inquired about less invasive treatment options. 
    • “Badhwar, a known pioneer of robotic aortic valve replacement (RAVR) and other robotic surgical techniques, said his team had developed a new technique for combining AVR and CABG—but it had not yet been tested on a patient. After a long discussion with McGee and her family about the risks, she agreed to the new-look surgical treatment.
    • “The combined surgery occurred on Oct. 31, 2024. Both the AVR and the CABG were performed using the same small incision on the far right of McGee’s chest. The surgery was a success, and a detailed account is expected to publish in The Annals of Thoracic Surgery.” ***
    • “Goya Raikar, MD, a member of Badhwar’s robotics team and an assistant professor a WVU, highlighted the progress this successful procedure represents for their work on advancing robotic surgical techniques.
    • “Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease,” he said. “Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients.”  
  • The Hill lets us know,
    • “A more potent form of fentanyl is contributing to the thousands of overdose deaths that happen every year, health officials warn.
    • “An extremely powerful derivative of fentanyl, called carfentanil, was detected in 513 overdose deaths between 2021 and early 2024, according to a report from the Centers for Disease Control and Prevention (CDC). 
    • “Carfentanil was designed to tranquilize large animals and is estimated to be 10,000 times stronger than morphine and 100 times stronger than fentanyl.  
    • “Just 2 milligrams is needed to tranquilize an elephant; that same amount is powerful enough to kill 50 people, according to a Department of Veteran Affairs report.
    • “Drug overdose deaths overall have been declining since 2023, according to the CDC. But they remain high in the United States, and the majority are connected to illegally manufactured fentanyls (IMFs).
    • “Carfentanil-related overdose deaths are becoming less rare, highlighting the “ever-changing illegal drug supply” that threatens the progress made in reducing overdose deaths, according to the report.” * * *
    • “Carfentanil-related deaths continued to rise this year, with a total of 238 people dying from the drug by June — a roughly 720 percent increase from the first half of 2023 to the first half of 2024.”
  • Per Medscape,
    • “Vaccines for treating and preventing cancer have long been considered a holy grail in oncology.
    • “But aside from a few notable exceptions — including the human papillomavirus (HPV) vaccine, which has dramatically reduced the incidence of HPV-related cancers, and a Bacillus Calmette-Guerin vaccine, which helps prevent early-stage bladder cancer recurrence — most have failed to deliver.
    • “Following a string of disappointments over the past decade, recent advances in the immunotherapy space are bringing renewed hope for progress.
    • “In an American Association for Cancer Research (AACR) series earlier this year, Catherine J. Wu, MD, predicted big strides for cancer vaccines, especially for personalized vaccines that target patient-specific neoantigens — the proteins that form on cancer cells — as well as vaccines that can treat diverse tumor types.
    • “A focus on neoantigens that arise from driver mutations in different tumor types could allow us to make progress in creating off-the-shelf vaccines,” said Wu, the Lavine Family Chair of Preventative Cancer Therapies at Dana-Farber Cancer Institute and a professor of medicine at Harvard Medical School, both in Boston.”
  • Fortune Well points out five symptoms that men over 40 should never ignore.
    • “Unexplained fatigue
    • “Chest discomfort
    • “Swelling in lower extremities
    • “Changes in exercise tolerance, and
    • “Loss of morning erections.”
  • NPR Shots reminds us,
    • “[I]nstead of chilling out in front of the TV after you polish off a scrumptious dessert, consider venturing out for a walk. It’s one of the easiest things you can do to boost your health after a meal, and even a short stroll can yield big benefits.
    • “The concept of post-meal walks has been around for centuries, notes Loretta DiPietro, a professor of exercise and nutrition science at the George Washington University Milken Institute School of Public Health.”

From the U.S. healthcare business front,

  • BioPharma Dive relates,
    • “BioAge Labs said it is terminating a mid-stage study of its obesity drug candidate azelaprag in combination with Eli Lilly’s tirzepatide due to safety concerns, causing its share price to slide by three-quarters in after-hours trading Friday.
    • “Eleven people who received azelaprag in STRIDES, BioAge’s Phase 2 study, showed elevated levels of liver enzymes that can warn of potential organ damage. As a result, the company is discontinuing dosing and halting further enrollment.
    • “The San Francisco Bay Area company raised $170 million in February and banked a $198 million initial public offering in September to fund its ambitious foray into metabolic drugs, not long after it pivoted from making treatments for age-related diseases.”
  • MedTech Dive adds,
    • “Edwards Lifesciences predicted Wednesday that an expanded indication in transcatheter aortic valve replacement (TAVR) and rapid growth in its newer mitral and tricuspid heart valve technologies will accelerate total company sales in 2026 and beyond.
    • “Edwards anticipates mid-2025 approval for TAVR in people with asymptomatic severe aortic stenosis, the company said during an investor day event.
    • “The Sapien TAVR system is Edwards’ biggest product but has seen growth slow this year as hospital heart teams dealt with capacity constraints. Hospitals, however, are investing to increase capacity and avoid delays in patient treatment, which will support prioritization of aortic stenosis cases long term, Edwards said in its presentation.” 
  • The Journal of Accountancy lets us know,
    • “A federal district court, finding that the Corporate Transparency Act (CTA) is likely unconstitutional, issued an order Tuesday prohibiting the enforcement of the CTA and the beneficial ownership information (BOI) reporting rule in the CTA’s accompanying regulations.
    • “The injunction, which according to the court should apply nationally, was issued in Texas Top Cop Shop, Inc. vs. Garland, No. 4:24-CV-478 (E.D. Texas 12/3/24).
    • “Under the injunction, the CTA and the BOI reporting rule cannot be enforced, and reporting companies need not comply with the CTA’s Jan. 1, 2025, BOI reporting deadline pending a further order of the court.
    • “The Financial Crimes Enforcement Network (FinCEN), which enforces the CTA, is reviewing the order, a spokesperson said Wednesday, pointing out that other courts have denied similar requests. The Justice Department (DOJ) filed a notice of appeal on Thursday night.
    • “An AICPA statement, released before the DOJ notice of appeal, acknowledged the potential effects of the injunction and urged CPAs assisting clients with BOI reporting to be prepared.
    • “Under the injunction, FinCEN is barred from enforcing BOI filing requirements while the case is pending,” the statement said. “Best practices dictate that at a minimum those assisting clients with BOI report filings gather the required information from the clients and are prepared to file the BOI report if the injunction is lifted. While it is unlikely that the injunction will be lifted prior to the final outcome of the proceedings, we advise being prepared in the event that there is a reversal.”